Katano Atsuto, Yamashita Hideomi
Department of Radiology, University of Tokyo Hospital, Bunkyo, Tokyo 113-8655, Japan.
Oncol Lett. 2022 Jun;23(6):191. doi: 10.3892/ol.2022.13311. Epub 2022 Apr 29.
With the advent of novel systemic therapies, such as molecular targeted therapy and immune checkpoint inhibitors, the treatment of advanced-stage cancer is markedly transitioning. The treatment for brain metastasis is influenced by these new therapies. Moreover, the frequency of brain metastasis is associated with cancer genetics. Since conventional cytotoxic chemotherapeutic drugs cannot easily cross the brain-blood barrier, radiotherapy plays a major role in the management of brain metastasis. Whole-brain radiotherapy (WBRT) has been frequently used, especially for multiple metastatic brain tumors; however, late adverse effects on cognitive function are a significant clinical problem of WBRT in patients with an otherwise good prognosis and overall survival rate. Some novel systemic agents are effective against brain metastasis. Moreover, advances in radiotherapy technology have made it possible to deliver optimal radiation doses to patients with brain metastasis, with fewer adverse events. Brain metastasis has a significant impact on the quality of life of patients with advanced-stage cancer; therefore, its appropriate management is an important factor in the comprehensive treatment of cancer.
随着分子靶向治疗和免疫检查点抑制剂等新型全身治疗方法的出现，晚期癌症的治疗正在发生显著转变。脑转移瘤的治疗也受到这些新疗法的影响。此外，脑转移的发生率与癌症遗传学有关。由于传统的细胞毒性化疗药物不易穿过血脑屏障，放射治疗在脑转移瘤的管理中起着主要作用。全脑放疗（WBRT）经常被使用，特别是对于多发转移性脑肿瘤；然而，对于预后和总生存率原本良好的患者，WBRT对认知功能的晚期不良反应是一个重大的临床问题。一些新型全身药物对脑转移有效。此外，放疗技术的进步使得向脑转移患者提供最佳辐射剂量成为可能，且不良事件较少。脑转移对晚期癌症患者的生活质量有重大影响；因此，对其进行适当管理是癌症综合治疗的一个重要因素。
