Vermeulen S S
Northwest Tumor Institute, Deke Slayton Center for Brain Cancer Studies, Seattle, Washington 98133, USA.
Semin Surg Oncol. 1998 Jan-Feb;14(1):64-9. doi: 10.1002/(sici)1098-2388(199801/02)14:1<64::aid-ssu8>3.0.co;2-0.
Previous prospective and retrospective trials have failed to demonstrate the best treatment approach for patients with brain metastases. As a result, fractionated whole brain radiotherapy (WBRT) has been the mainstay of treatment for several decades. However, with improved surgical techniques and the advent of radiosurgical procedures to treat single and multiple metastases, the continued value of WBRT is in question. This is particularly true in the treatment of a favorable patient subset where the risks of long-term morbidity need to be addressed. This article reviews the trials of the Radiation Therapy Oncology Group (RTOG) and other select radiotherapy brain metastases trials, and compares their morbidities and outcomes to surgical and radiosurgical techniques. It is unfortunate that the inherent selection bias in most retrospective studies makes comparisons difficult. Therefore, to better understand the roles of WBRT, surgery, and radiosurgery in the treatment of brain metastases, additional randomized studies need to be conducted on homogeneous patient groups.
既往的前瞻性和回顾性试验均未能证实针对脑转移瘤患者的最佳治疗方法。因此，分次全脑放疗（WBRT）几十年来一直是主要的治疗手段。然而，随着手术技术的改进以及用于治疗单发和多发转移瘤的放射外科手术的出现，WBRT的持续价值受到质疑。在治疗预后良好的患者亚组时尤其如此，因为需要解决长期发病风险问题。本文回顾了放射治疗肿瘤学组（RTOG）的试验以及其他一些选定的脑转移瘤放疗试验，并将它们的发病率和治疗结果与手术和放射外科技术进行了比较。遗憾的是，大多数回顾性研究中固有的选择偏倚使得比较变得困难。因此，为了更好地理解WBRT、手术和放射外科在脑转移瘤治疗中的作用，需要对同质患者群体进行更多的随机研究。
