Benkhaled Sofian, Schiappacasse Luis, Awde Ali, Kinj Remy
Department of Radiation Oncology, UNIL-CHUV, Rue du Bugnon 46, 1011 Lausanne, Switzerland.
Cancers (Basel). 2024 Mar 8;16(6):1093. doi: 10.3390/cancers16061093.
The management of brain metastases (BM) remains an important and complex issue in the treatment of cancer-related neurological complications. BM are particularly common in patients diagnosed with lung, melanoma, or breast cancer. Over the past decade, therapeutic approaches for the majority of BM patients have changed. Considering and addressing the fact that patients with BM are living longer, the need to provide effective local control while preserving quality of life and neurocognition is fundamental. Over the past decade, SRS and SRT have become a more commonly chosen treatment option for BM. Despite significant advances in the treatment of BM, numerous questions remain regarding patient selection and optimal treatment sequencing. Clinical trials are critical to advancing our understanding of BM, especially as more therapeutic alternatives become available. Therefore, it is imperative for interdisciplinary teams to improve their understanding of the latest advances in SRS-SRT. This review aims to comprehensively explore SRS and SRT as treatments for BM, covering clinical considerations in their application (e.g., patient selection and eligibility), managing limited and multiple intact BM, addressing brainstem metastases, exploring combination therapies with systemic treatments, and considering the health economic perspective.
脑转移瘤（BM）的管理仍然是癌症相关神经并发症治疗中的一个重要且复杂的问题。BM在被诊断为肺癌、黑色素瘤或乳腺癌的患者中尤为常见。在过去十年中，大多数BM患者的治疗方法发生了变化。考虑到并应对BM患者寿命延长这一事实，在保持生活质量和神经认知的同时提供有效的局部控制至关重要。在过去十年中，立体定向放射外科（SRS）和立体定向放射治疗（SRT）已成为BM更常选用的治疗选择。尽管BM治疗取得了重大进展，但在患者选择和最佳治疗顺序方面仍存在许多问题。临床试验对于增进我们对BM的理解至关重要，尤其是随着更多治疗选择的出现。因此，跨学科团队必须加深对SRS - SRT最新进展的理解。本综述旨在全面探讨SRS和SRT作为BM的治疗方法，涵盖其应用中的临床考量（如患者选择和资格）、处理有限和多个完整的BM、应对脑干转移瘤、探索与全身治疗的联合疗法以及从卫生经济学角度进行考量。
