Moskalenko Marina, Robin Tyler P
Department of Radiation Oncology, University of Colorado School of Medicine, Aurora, CO, USA.
Transl Cancer Res. 2021 May;10(5):2527-2536. doi: 10.21037/tcr-20-3027.
Radiation therapy plays a key role in the management of intracranial metastatic disease. Historically, systemic therapy was able to address extracranial disease but not cross the blood-brain barrier and radiation therapy and surgery were the only mechanisms to treat intracranial metastases. There are now several examples of contemporary systemic therapies with central nervous system efficacy in some patients. With such improvements in systemic therapies, patients are living longer and the optimal management of brain metastases is becoming an increasingly important clinical priority. However, the role of radiation therapy remains critical in treating brain metastases. The concurrent use of new systemic therapies with radiation brings about novel and significant questions regarding potential synergy between these therapies in the brain in regard to both oncologic efficacy and toxicity. One important systemic therapy to consider is immune checkpoint inhibitors. These drugs are now at the forefront of management of many malignancies and have changed the landscape of treatment for many common cancers, particularly those with a predilection for brain metastases. In this review we will examine the existing data on the efficacy and toxicity of concurrent radiation therapy and immunotherapy for brain metastases and explore potential mechanisms underlying the published clinical observations.
放射治疗在颅内转移性疾病的治疗中起着关键作用。从历史上看，全身治疗能够治疗颅外疾病，但无法穿过血脑屏障，放射治疗和手术是治疗颅内转移瘤的唯一手段。现在有几个当代全身治疗的例子，在一些患者中具有中枢神经系统疗效。随着全身治疗的这些改善，患者的生存期延长，脑转移瘤的最佳治疗正成为日益重要的临床优先事项。然而，放射治疗在治疗脑转移瘤方面的作用仍然至关重要。新的全身治疗与放射治疗同时使用，在肿瘤疗效和毒性方面，引发了关于这些治疗在脑内潜在协同作用的新的重大问题。一种重要的全身治疗方法是免疫检查点抑制剂。这些药物现在处于许多恶性肿瘤治疗的前沿，改变了许多常见癌症的治疗格局，特别是那些易发生脑转移的癌症。在这篇综述中，我们将研究关于脑转移瘤同步放射治疗和免疫治疗的疗效和毒性的现有数据，并探讨已发表临床观察结果背后的潜在机制。
