University Hospital Zurich: UniversitatsSpital Zurich, Zurich, Switzerland.
J Neurooncol. 2021 Apr;152(2):395-404. doi: 10.1007/s11060-021-03714-w. Epub 2021 Feb 23.
The treatment of brain metastases (BM) has changed considerably in recent years and in particular, the management of multiple BM is currently undergoing a paradigm shift and treatment may differ from current guidelines. This survey was designed to analyze the patterns of care in the management of multiple BM.
An online survey consisting of 36 questions was distributed to the members of the German Society for Radiation Oncology (DEGRO).
In total, 193 physicians out of 111 institutions within the German Society for Radiation oncology responded to the survey. Prognostic scores for decision making were not used regularly. Whole brain radiotherapy approaches (WBRT) are the preferred treatment option for patients with multiple BM, although stereotactic radiotherapy treatments are chosen by one third depending on prognostic scores and overall number of BM. Routine hippocampal avoidance (HA) in WBRT is only used by a minority. In multiple BM of driver-mutated non-small cell lung cancer origin up to 30% favor sole TKI therapy as upfront treatment and would defer upfront radiotherapy.
In multiple BM WBRT without hippocampal avoidance is still the preferred treatment modality of choice regardless of GPA and mutational status, while SRT is only used in patients with good prognosis. Evidence for both, SRS and hippocampal avoidance radiotherapy, is growing albeit the debate over the appropriate treatment in multiple BM is yet not fully clarified. Further prospective assessment of BM management-ideally as randomized trials-is required to align evolving concepts with the proper evidence and to update current guidelines.
近年来，脑转移瘤（BM）的治疗发生了重大变化，特别是目前正在对多发性 BM 的治疗进行范式转变，其治疗方法可能与现行指南不同。本调查旨在分析多发性 BM 治疗中的护理模式。
向德国放射肿瘤学会（DEGRO）的成员分发了一份包含 36 个问题的在线调查。
共有 193 名医生对来自 111 个德国放射肿瘤学会机构的调查做出了回应。预测评分并未被常规用于决策。尽管根据预后评分和 BM 的总数，有三分之一的患者选择立体定向放射治疗，但全脑放疗（WBRT）仍是多发性 BM 患者的首选治疗方案。WBRT 中常规进行海马回避（HA）的比例较少。对于由驱动基因突变的非小细胞肺癌引起的多发性 BM，高达 30%的患者倾向于将单一 TKI 治疗作为一线治疗，并将放疗推迟。
无论 GPA 和突变状态如何，WBRT 不进行海马回避仍然是多发性 BM 的首选治疗方式，而 SRT 仅用于预后良好的患者。尽管对多发性 BM 中适当治疗的争论尚未完全澄清，但 SRS 和海马回避放疗的证据都在不断增加。需要进一步对 BM 管理进行前瞻性评估——理想情况下是作为随机试验——以将不断发展的概念与适当的证据相结合，并更新当前的指南。
