Service de radiothérapie, groupe Oncorad Garonne, clinique Pasteur, l'« Atrium », 1, rue de la Petite-Vitesse, 31300 Toulouse, France; Centre régional de radiochirurgie stéréotaxique, CHU Rangueil, avenue Jean-Poulhès, 31052 Toulouse cedex, France.
Département universitaire de radiothérapie, centre Paul-Strauss, Unicancer, 3, rue de la Porte-de-l'Hôpital, 67065 Strasbourg cedex, France.
Cancer Radiother. 2022 Feb-Apr;26(1-2):129-136. doi: 10.1016/j.canrad.2021.11.010. Epub 2021 Dec 23.
We present the update of the recommendations of the French society for radiation oncology on radiation therapy for the management of brain metastases. It has evolved in recent years and has become more complex. As the life expectancy of patients has increased and retreatments have become more frequent, side effects must be absolutely avoided. Cognitive side effects must in particular be prevented, and the most modern radiation therapy techniques must be used systematically. New prognostic classifications specific to the primary tumour of patients, advances in imaging and radiation therapy technology and new systemic therapeutic strategies, are making treatment more relevant. Stereotactic radiation therapy has supplanted whole-brain radiation therapy both for patients with metastases in place and for those who underwent surgery. Hippocampus protection is possible with intensity-modulated radiation therapy. Its relevance in terms of cognitive functioning should be more clearly demonstrated but the requirement for its use is constantly increasing. New targeted cancer treatment therapies based on the nature of the primitive have complicated the notion of the place and timing of radiation therapy and the discussion during multidisciplinary care meeting to indicate the best sequences is becoming a challenging issue as data on the interaction between treatments remain to be documented. In the end, although aimed at patients in the palliative phase, the management of brain metastases is one of the locations for which technical reflection is the most challenging and treatment become increasingly personalized.
我们呈现了法国放射肿瘤学会关于脑转移瘤放射治疗管理建议的更新。近年来，这些建议发生了演变，变得更加复杂。随着患者预期寿命的延长和再治疗的频率增加，必须绝对避免副作用。特别是要预防认知副作用，必须系统地使用最现代的放射治疗技术。针对患者原发肿瘤的新的预后分类、成像和放射治疗技术的进步以及新的全身治疗策略，使治疗更加合理。立体定向放射治疗已经取代了全脑放射治疗，无论是对于有转移灶的患者还是接受手术的患者。强度调制放射治疗可以保护海马体。它在认知功能方面的相关性应该更清楚地证明，但对其使用的要求不断增加。基于原始性质的新的靶向癌症治疗疗法使放射治疗的位置和时间的概念复杂化，并且在多学科护理会议上讨论表明最佳序列成为一个具有挑战性的问题，因为关于治疗相互作用的数据仍有待记录。最终，尽管脑转移瘤的治疗旨在针对姑息治疗阶段的患者，但它是技术反思最具挑战性且治疗越来越个性化的部位之一。
