Khan Muhammad, Arooj Sumbal, Li Rong, Tian Yunhong, Zhang Jian, Lin Jie, Liang Yingying, Xu Anan, Zheng Ronghui, Liu Mengzhong, Yuan Yawei
Department of Radiation Oncology, State Key Laboratory of Respiratory Disease, Affiliated Cancer Hospital & Institute of Guangzhou Medical University, Guangzhou Medical University, Guangzhou, China.
Department of Oncology, First affiliated Hospital of Anhui Medical University, Hefei, China.
Front Oncol. 2020 Jul 7;10:781. doi: 10.3389/fonc.2020.00781. eCollection 2020.
Randomized controlled trials have failed to report any survival advantage for WBRT combined with SRS in the management of brain metastases, despite the enhanced local and distant control in comparison to each treatment alone. Literature review have revealed important role of primary histology of the tumor when dealing with brain metastases. NSCLC responds better to combined approach even when there was only single brain metastasis present while breast cancer has registered better survival with SRS alone probably due to better response of primary tumor to advancement in surgical and chemotherapeutic agents. Furthermore, mutation status (EGFR/ALK) in lung cancer and receptor status (ER/PR/HER2) in breast cancer also exhibit diversity in their response to radiotherapy. Radioresistant tumors like renal cell carcinoma and melanoma brain metastases have achieved better results when treated with SRS alone. Secondly, single brain metastasis may benefit from local and distant brain control achieved with combined treatment. These diverse outcomes suggest a primary histology-based analysis of the radiotherapy regimens (WBRT, SRS, or their combination) would more ideally establish the role of radiotherapy in the management of brain metastases. Molecularly targeted therapeutic and immunotherapeutic agents have revealed synergism with radiation therapy particularly SRS in treating cancer patients with brain metastases. Clinical updates in this regard have also been reviewed.
随机对照试验未能报告在脑转移瘤治疗中，全脑放疗（WBRT）联合立体定向放射治疗（SRS）有任何生存优势，尽管与单独使用每种治疗方法相比，联合治疗可增强局部和远处控制。文献综述显示，在处理脑转移瘤时，肿瘤的原发组织学起着重要作用。即使仅存在单个脑转移瘤，非小细胞肺癌（NSCLC）对联合治疗的反应也更好，而乳腺癌单独使用SRS的生存率更高，这可能是由于原发肿瘤对手术和化疗药物进展的反应更好。此外，肺癌中的突变状态（表皮生长因子受体/间变性淋巴瘤激酶，EGFR/ALK）和乳腺癌中的受体状态（雌激素受体/孕激素受体/人表皮生长因子受体2，ER/PR/HER2）对放疗的反应也存在差异。肾细胞癌和黑色素瘤脑转移瘤等放射抗拒性肿瘤单独使用SRS治疗时取得了更好的效果。其次，单个脑转移瘤可能受益于联合治疗实现的局部和远处脑控制。这些不同的结果表明，基于原发组织学对放疗方案（WBRT、SRS或其联合）进行分析，将更理想地确定放疗在脑转移瘤治疗中的作用。分子靶向治疗和免疫治疗药物已显示出与放射治疗特别是SRS在治疗脑转移瘤癌症患者方面具有协同作用。本文还综述了这方面的临床进展。
