Popp Ilinca, Hartong Nanna E, Nieder Carsten, Grosu Anca-L
Department of Radiation Oncology, Medical Center-University of Freiburg, Faculty of Medicine, University of Freiburg, 79106 Freiburg, Germany.
German Cancer Consortium (DKTK), German Cancer Research Center (DKFZ), Partner Site Freiburg, 69120 Heidelberg, Germany.
Cancers (Basel). 2023 Jun 15;15(12):3193. doi: 10.3390/cancers15123193.
(1) Background: In recent decades, the use of whole-brain radiation therapy (WBRT) in the treatment of brain metastases has significantly decreased, with clinicians fearing adverse neurocognitive events and data showing limited efficacy regarding local tumor control and overall survival. The present study thus aimed to reassess the role that WBRT holds in the treatment of brain metastases. (2) Methods: This review summarizes the available evidence from 1990 until today supporting the use of WBRT, as well as new developments in WBRT and their clinical implications. (3) Results: While one to four brain metastases should be exclusively treated with radiosurgery, WBRT does remain an option for patients with multiple metastases. In particular, hippocampus-avoidance WBRT, WBRT with dose escalation to the metastases, and their combination have shown promising results and offer valid alternatives to local stereotactic radiotherapy. Ongoing and published prospective trials on the efficacy and toxicity of these new methods are presented. (4) Conclusions: Unlike conventional WBRT, which has limited indications, modern WBRT techniques continue to have a significant role to play in the treatment of multiple brain metastases. In which situations radiosurgery or WBRT should be the first option should be investigated in further studies. Until then, the therapeutic decision must be made individually depending on the oncological context.
(1) 背景：近几十年来，全脑放射治疗（WBRT）在脑转移瘤治疗中的应用显著减少，临床医生担心出现不良神经认知事件，且数据显示其在局部肿瘤控制和总生存期方面疗效有限。因此，本研究旨在重新评估WBRT在脑转移瘤治疗中的作用。(2) 方法：本综述总结了1990年至今支持使用WBRT的现有证据，以及WBRT的新进展及其临床意义。(3) 结果：虽然一至四个脑转移瘤应首选放射外科治疗，但WBRT仍是多发转移瘤患者的一种选择。特别是，海马回避WBRT、对转移瘤进行剂量递增的WBRT及其联合应用已显示出有前景的结果，并为局部立体定向放射治疗提供了有效的替代方案。本文还介绍了关于这些新方法疗效和毒性的正在进行及已发表的前瞻性试验。(4) 结论：与适应证有限的传统WBRT不同，现代WBRT技术在多发脑转移瘤的治疗中仍继续发挥重要作用。放射外科或WBRT在哪些情况下应作为首选，应在进一步研究中进行探讨。在此之前，治疗决策必须根据肿瘤学背景进行个体化制定。
