Kaul David, Berghoff Anna Sophie, Grosu Anca-Ligia, Lucas Carolin Weiss, Guckenberger Matthias
Dtsch Arztebl Int. 2021 Nov 12;118(Forthcoming):759-66. doi: 10.3238/arztebl.m2021.0332.
Advances in systemic treatment and in brain imaging have led to a higher incidence of diagnosed brain metastases. In the treatment of brain metastases, stereotactic radiotherapy and radiosurgery, systemic immunotherapy, and targeted drug therapy are important evidence-based options. In this review, we summarize the available evidence on the treatment of brain metastases of the three main types of cancer that give rise to them: non-small-cell lung cancer, breast cancer, and malignant melanoma.
This narrative review is based on pertinent original articles, meta-analyses, and systematic reviews that were retrieved by a selective search in PubMed. These publications were evaluated and discussed by an expert panel including radiation oncologists, neurosurgeons, and oncologists.
There have not yet been any prospective randomized trials concerning the optimal combination of local stereotactic radiotherapy/radiosurgery and systemic immunotherapy or targeted therapy. Retrospective studies have consistently shown a benefit from early combined treatment with systemic therapy and (in particular) focal radiotherapy, compared to sequential treatment. Two metaanalyses of retrospective data from cohorts consisting mainly of patients with non-small-cell lung cancer and melanoma revealed longer overall survival after combined treatment with focal radiotherapy and checkpoint inhibitor therapy (rate of 12-month overall survival for combined versus non-combined treatment: 64.6% vs. 51.6%, p <0.001). In selected patients with small, asymptomatic brain metastases in non-critical locations, systemic therapy without focal radiotherapy can be considered, as long as follow-up with cranial magnetic resonance imaging can be performed at close intervals.
Brain metastases should be treated by a multidisciplinary team, so that the optimal sequence of local and systemic therapies can be determined for each individual patient.
全身治疗和脑成像技术的进步导致脑转移瘤的诊断发病率更高。在脑转移瘤的治疗中，立体定向放射治疗和放射外科手术、全身免疫治疗以及靶向药物治疗是重要的循证选择。在本综述中，我们总结了关于由三种主要癌症类型引发的脑转移瘤治疗的现有证据，这三种癌症分别是非小细胞肺癌、乳腺癌和恶性黑色素瘤。
本叙述性综述基于通过在PubMed中进行选择性检索获得的相关原始文章、荟萃分析和系统评价。这些出版物由包括放射肿瘤学家、神经外科医生和肿瘤学家在内的专家小组进行评估和讨论。
目前尚无关于局部立体定向放射治疗/放射外科手术与全身免疫治疗或靶向治疗的最佳组合的前瞻性随机试验。回顾性研究一致表明，与序贯治疗相比，早期联合全身治疗和（特别是）局部放疗有益。两项对主要由非小细胞肺癌和黑色素瘤患者组成的队列的回顾性数据进行的荟萃分析显示，局部放疗与检查点抑制剂联合治疗后总生存期更长（联合治疗与非联合治疗的12个月总生存率：64.6%对51.6%，p<0.001）。在非关键部位有小的无症状脑转移瘤的特定患者中，只要能密切间隔进行头颅磁共振成像随访，可考虑不进行局部放疗的全身治疗。
脑转移瘤应由多学科团队进行治疗，以便为每个患者确定局部和全身治疗的最佳顺序。
