O'Neill B P, Buckner J C, Coffey R J, Dinapoli R P, Shaw E G
Department of Neurology, Mayo Clinic Rochester, Minnesota 55905.
Mayo Clin Proc. 1994 Nov;69(11):1062-8. doi: 10.1016/s0025-6196(12)61374-3.
To describe current concepts in the diagnosis and treatment of brain metastases.
More than 25% of all autopsy-proven brain metastases have a pulmonary source. Most brain metastases manifest with a combination of focal and generalized symptoms and signs. Typically, patients have subacute, progressive symptoms. In most situations, a computed tomographic scan of the head provides sufficient neuroimaging and allows one to monitor the effects of therapy. Magnetic resonance imaging has become increasingly useful in the diagnosis and management of brain metastases. It can detect computed tomographic occult metastases, identify associated leptomeningeal disease, and reveal early therapeutic complications.
Treatment options for patients with brain metastases include corticosteroids, whole-brain radiation therapy (WBRT), surgical intervention, stereotactic radiosurgical techniques, and chemotherapy. Corticosteroids produce prompt improvement in most patients; however, prolonged use is associated with considerable risks. For most patients, WBRT is the preferred treatment. Nonetheless, it has associated nonneurologic and neurologic complications, some of which are serious. In patients with a single metastasis, surgical removal should be considered. Recent studies have suggested that resection of a single metastatic lesion followed by radiation therapy offers better survival than does radiation therapy alone. The subsequent administration of WBRT after radiosurgical treatment has become standard practice. The role of chemotherapy is uncertain.
描述脑转移瘤诊断和治疗的当前概念。
在所有经尸检证实的脑转移瘤中，超过25% 有肺部来源。大多数脑转移瘤表现为局灶性和全身性症状及体征的组合。通常，患者有亚急性、进行性症状。在大多数情况下，头部计算机断层扫描提供了足够的神经影像学检查，并能让人们监测治疗效果。磁共振成像在脑转移瘤的诊断和管理中越来越有用。它可以检测出计算机断层扫描隐匿性转移瘤，识别相关的软脑膜疾病，并揭示早期治疗并发症。
脑转移瘤患者的治疗选择包括皮质类固醇、全脑放射治疗（WBRT）、手术干预、立体定向放射外科技术和化疗。皮质类固醇能使大多数患者迅速改善；然而，长期使用会带来相当大的风险。对于大多数患者，WBRT是首选治疗方法。尽管如此，它有相关的非神经和神经并发症，其中一些很严重。对于有单个转移瘤的患者，应考虑手术切除。最近的研究表明，切除单个转移瘤后进行放射治疗比单纯放射治疗能提供更好的生存率。放射外科治疗后随后给予WBRT已成为标准做法。化疗的作用尚不确定。
