Department of Oncology and Palliative Medicine, Nordland Hospital, Bodø, Norway; Department of Clinical Medicine, Faculty of Health Sciences, UiT-The Arctic University of Norway, Tromsø, Norway.
Department of Radiation Oncology, University Hospital Zurich, University of Zurich, Zurich, Switzerland.
Semin Radiat Oncol. 2023 Apr;33(2):129-138. doi: 10.1016/j.semradonc.2023.01.005.
Whole-brain radiation therapy (WBRT) has commonly been prescribed to palliate symptoms from brain metastases, to reduce the risk of local relapse after surgical resection, and to improve distant brain control after resection or radiosurgery. While targeting micrometastases throughout the brain can be considered advantageous, the simultaneous exposure of healthy brain tissue might cause adverse events. Attempts to mitigate the risk of neurocognitive decline after WBRT include the selective avoidance of the hippocampi, among others. Besides selective dose reduction, dose escalation to boost volumes, for example, simultaneous integrated boost, aiming at increased tumor control probability is technically feasible. While up-front radiotherapy for newly diagnosed brain metastases often employs radiosurgery or other techniques targeting visible lesions only, sequential (delayed) salvage treatment with WBRT might still become necessary. In addition, the presence of leptomeningeal tumors or very widespread parenchymatous brain metastases might prompt clinicians to prescribe early WBRT.
全脑放疗（WBRT）常用于缓解脑转移瘤的症状，降低手术切除后局部复发的风险，并改善切除或放射外科治疗后的远处脑控制。虽然靶向治疗整个大脑中的微转移可能是有利的，但同时暴露于健康的脑组织可能会导致不良事件。为了减轻 WBRT 后神经认知功能下降的风险，人们尝试选择性地避开海马体等部位。除了选择性地降低剂量外，通过增加剂量来提高体积，例如，同时进行综合增量，旨在提高肿瘤控制概率，在技术上是可行的。虽然对于新诊断的脑转移瘤，通常采用放射外科或仅针对可见病变的其他技术进行前期放疗，但仍可能需要进行序贯（延迟）挽救性 WBRT 治疗。此外，软脑膜肿瘤或非常广泛的脑实质转移瘤的存在可能促使临床医生早期开具 WBRT 处方。
