Vecht C J
Dept. of Neuro-oncology Daniel den Hoed Cancer Centre, University Hospital Rotterdam, The Netherlands.
J Neurol. 1998 Mar;245(3):127-31. doi: 10.1007/s004150050191.
Brain metastasis is a common complication occurring in about 15-20% of all cancer patients. For the initial management, distinguishing between three types of presentation is essential: de novo brain metastasis, simultaneous presentation of both brain metastasis and the primary tumour (usually lung carcinoma), and the presentation of a patient known to have systemic cancer developing a brain metastasis. For de novo brain metastasis, surgery is required, and detecting the primary tumour is of limited value. For simultaneous presentation, both a craniotomy and a thoracotomy may be indicated and may lead to cure in a number of cases. For a sequential presentation, the outcome is determined by a number of independent prognostic factors: age, performance status, and the extent of metastatic disease. In relatively young patients with a single brain metastasis, good performance status and no progression of systemic disease, treatment by either surgery or radiosurgery in combination with whole brain radiation therapy is indicated. Otherwise, as in multiple brain metastases, radiation therapy only is the main treatment. For symptomatic therapy of brain oedema or increased intracranial pressure, dexamethasone is administered. The standard doses of dexamethasone may vary between 4 and 16 mg/day, depending on the severity of symptoms.
脑转移是一种常见的并发症，约15%-20%的癌症患者会出现。对于初始治疗，区分三种表现类型至关重要：新发脑转移、脑转移与原发肿瘤同时出现（通常为肺癌）以及已知患有全身性癌症的患者发生脑转移。对于新发脑转移，需要进行手术，而检测原发肿瘤价值有限。对于同时出现的情况，可能需要进行开颅手术和开胸手术，在一些病例中可能会治愈。对于相继出现的情况，预后由多个独立的预后因素决定：年龄、身体状况和转移疾病的范围。在相对年轻、仅有单个脑转移、身体状况良好且全身疾病无进展的患者中，建议采用手术或立体定向放射外科联合全脑放射治疗。否则，如在多发脑转移的情况下，主要治疗方法仅为放射治疗。对于脑水肿或颅内压升高的对症治疗，可使用地塞米松。地塞米松的标准剂量可能因症状严重程度而异，为每日4至16毫克。
