Bernstock Joshua D, Dadario Nicholas B, Valdés Pablo A, Gerstl Jakob V E, Johnston Benjamin R, Spanehl Lennard, Gessler Florian A, Peruzzi Pierpaolo, Smith Timothy R, Friedman Gregory K, Bi Wenya Linda, Chiocca E A, Aizer Ayal, Arnaout Omar
Department of Neurosurgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA.
Department of Neurosurgery, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts, USA.
Neurosurg Pract. 2025 Oct 28;6(4):e000185. doi: 10.1227/neuprac.0000000000000185. eCollection 2025 Dec.
The emergence of modern adjuvant therapies has significantly improved outcomes for patients with brain metastases. However, treatment-related side effects present an ongoing challenge, particularly, treatment-induced necrosis characterized by perilesional edema and inflammation. Standard management with steroids compromises the efficacy of otherwise efficacious immunotherapeutic approaches. This position paper critiques traditional management strategies that rely heavily on systemic corticosteroid therapy-often ineffective in providing lasting relief and associated with serious side effects-and proposes a paradigm shift that prioritizes surgical resection. Resection facilitates prompt edema reduction with a low recurrence rate of symptoms and mitigates the adverse effects of prolonged corticosteroid use. We propose increased consideration for resecting symptomatic radiation necrosis to facilitate improved efficacy of immunotherapies in patients with brain metastases.
现代辅助治疗的出现显著改善了脑转移患者的治疗效果。然而，治疗相关的副作用仍然是一个持续存在的挑战，特别是以病灶周围水肿和炎症为特征的治疗诱导性坏死。使用类固醇的标准治疗方法会损害其他有效免疫治疗方法的疗效。本立场文件批评了严重依赖全身皮质类固醇治疗的传统管理策略——这种策略通常无法提供持久缓解且伴有严重副作用——并提出了一种优先考虑手术切除的范式转变。切除有助于迅速减轻水肿，症状复发率低，并减轻长期使用皮质类固醇的不良反应。我们建议更多地考虑切除有症状的放射性坏死，以提高免疫疗法对脑转移患者的疗效。
