Ariello Krista, Tan Hendrick, Soliman Hany
Faculty of Arts and Science, University of Toronto, Toronto, ON, Canada.
Department of Radiation Oncology, Odette Cancer Centre, Sunnybrook Health Sciences Centre, Toronto, ON, Canada.
Ann Palliat Med. 2021 Jan;10(1):923-935. doi: 10.21037/apm-20-1036. Epub 2020 Dec 31.
Development of brain metastases are common in patients with advanced malignancies leading to significant morbidity and mortality. Although overall survival is an important endpoint in these patients, neurocognition and health related quality of life (HRQoL) more accurately highlights the impact of the disease and its treatment on patients. Whole brain radiotherapy (WBRT) has historically played a key role in the management of these patients, especially those with multiple brain metastases. Clinical trials have supported the use of stereotactic radiosurgery (SRS) alone in patients with limited brain metastases sparing neurocognitive function and HRQoL as compared to the combination of SRS plus WBRT. Furthermore, new systemic agents are increasingly being used in clinical practice and have shown promise in patients with brain metastases. The upcoming clinical trials are tasked with defining treatment guidelines that are more specific to patient and tumour factors incorporating radiation, surgery, and systemic therapy. The validity of findings in these trials rest on the rigor of the study methodology and the utilisation of validated assessment tools for neurocognition and HRQoL. This review aims to appraise and summarise the neurocognitive and HRQoL tools used in modern brain metastases trials.
脑转移在晚期恶性肿瘤患者中很常见，会导致严重的发病率和死亡率。尽管总生存期是这些患者的一个重要终点，但神经认知和健康相关生活质量（HRQoL）能更准确地突出疾病及其治疗对患者的影响。从历史上看，全脑放疗（WBRT）在这些患者的管理中发挥了关键作用，尤其是那些有多发脑转移的患者。临床试验支持对于脑转移灶有限的患者单独使用立体定向放射外科治疗（SRS），与SRS加WBRT联合使用相比，这样能保留神经认知功能和HRQoL。此外，新型全身治疗药物在临床实践中越来越多地被使用，并已在脑转移患者中显示出前景。即将开展的临床试验的任务是制定更针对患者和肿瘤因素的治疗指南，将放疗、手术和全身治疗纳入其中。这些试验结果的有效性取决于研究方法的严谨性以及对神经认知和HRQoL使用经过验证的评估工具。本综述旨在评估和总结现代脑转移试验中使用的神经认知和HRQoL工具。
