Department of Radiation Oncology, Gil Medical Center, Gachon University College of Medicine, Incheon 21565, Republic of Korea.
Medicina (Kaunas). 2023 Oct 12;59(10):1815. doi: 10.3390/medicina59101815.
Brain metastases (BMs) are one of the most common metastatic lesions in adult cancer patients and the most common intracranial neoplasms in adult patients. Especially for multiple BMs, historically, whole-brain radiotherapy (WBRT) has been performed as the mainstay of therapy, which improves neurological symptoms and median survival. However, WBRT could negatively impact the patient's quality of life due to late complications. Owing to these complications, attempts have been made to use the latest radiotherapy (LRT) such as stereotactic radiosurgery (SRS) and intensity-modulated radiotherapy (IMRT) to treat BMs. However, for the extensive BMs (ranging from tens to hundreds), there are currently no prospective studies comparing WBRT with LRT such as IMRT or SRS. For extensive brain metastases, LRT cannot be the best option. Instead, upfront WBRT should be considered given its advantages and disadvantages, rather than LRT. We hope that faster and more reliable LRT for extensive BMs will be applicable for clinical practice without any clinical concerns in the near future.
脑转移瘤（BMs）是成年癌症患者中最常见的转移病灶之一，也是成年患者中最常见的颅内肿瘤。特别是对于多发性 BMs，历史上，全脑放疗（WBRT）一直是主要的治疗方法，它可以改善神经症状和中位生存期。然而，WBRT 可能会由于晚期并发症而对患者的生活质量产生负面影响。由于这些并发症，人们试图使用最新的放疗（LRT），如立体定向放射外科（SRS）和调强放疗（IMRT）来治疗 BMs。然而，对于广泛的 BMs（范围从数十个到数百个），目前还没有前瞻性研究比较 WBRT 与 LRT，如 IMRT 或 SRS。对于广泛的脑转移瘤，LRT 可能不是最佳选择。相反，鉴于 WBRT 的优缺点，应考虑 upfront WBRT，而不是 LRT。我们希望在不久的将来，对于广泛的 BMs，能够有更快、更可靠的 LRT 适用于临床实践，而不会有任何临床担忧。
