Seattle Cancer Care Alliance, Division of Oncology, Department of Medicine, University of Washington Medicine, Fred Hutchinson Cancer Research Center, Seattle, WA, USA.
Center for Neuro-Oncology, Dana-Farber Cancer Institute, 450 Brookline Avenue, Boston, MA, 02215, USA.
Curr Neurol Neurosci Rep. 2020 Jun 6;20(7):26. doi: 10.1007/s11910-020-01039-1.
The management of brain and leptomeningeal metastases has changed significantly over the past decade.
Historically, radiation therapy had been the mainstay of treatment. Several strategies to limit toxicities with radiation have been developed in the recent years. Increasingly systemic therapy options are being considered an important therapeutic option for CNS metastases. Numerous novel small molecule inhibitors and immunotherapy agents have intracranial activity to varying degrees, in addition to good extracranial disease control. Overall, the prognosis of select patients with CNS metastases has improved over the past several years with advent of new therapeutic strategies. Systemic therapy options with CNS benefit should be considered in select patients with small and asymptomatic CNS metastases. Further areas of research focus on molecular alterations predisposing to CNS metastases, identification of small molecule inhibitors with CNS activity, and the combination of radiation therapy and immunotherapy.
过去十年中，脑和软脑膜转移的治疗发生了显著变化。
从历史上看，放射治疗一直是治疗的主要手段。近年来，已经开发出了几种限制放射毒性的策略。越来越多的系统治疗方案被认为是治疗中枢神经系统转移的重要治疗选择。除了良好的颅外疾病控制外，许多新型小分子抑制剂和免疫治疗药物在不同程度上具有颅内活性。总的来说，随着新治疗策略的出现，过去几年中选择的中枢神经系统转移患者的预后有所改善。对于有小且无症状的中枢神经系统转移的患者，应考虑具有中枢神经系统获益的全身治疗方案。进一步的研究重点包括易发生中枢神经系统转移的分子改变、具有中枢神经系统活性的小分子抑制剂的鉴定，以及放射治疗和免疫治疗的联合应用。
