Adjuvant treatment of brain metastases.

F. Lohr, A. Pirzkall, H. Hof, K. Fleckenstein, J. Debus, J. Debus
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引用次数: 77

Abstract

With an incidence of 15/10(5) in the general population, brain metastases constitute a serious, debilitating complication in cancer patients. The majority of those patients suffer from more than one metastasis, but up to 30% to 40% present with a solitary lesion. Whole-brain radiotherapy (WBRT) extends median survival from 1 to 2 months for treatment with steroids only, to 4 to 6 months in most series. However, long-term survival (>1-2 years) is observed in up to 10% of patients with favorable prognostic factors, such as solitary lesions, good Karnofsky performance status, and absence of extracranial disease. For those patients, individually optimized treatment is worthwhile. For good-prognosis patients with controlled extracranial disease, surgery in combination with postoperative WBRT should be considered, especially when fast relief of symptoms is mandated. For surgically inaccessible solitary lesions below a size threshold of approximately 30 ccm, stereotactic radiosurgery (RS), although never compared to surgery in a randomized fashion, seems to yield comparable results and is the treatment of choice for more than one lesion in appropriately selected patients. Nevertheless, a number of questions concerning the optimal treatment regimens for brain metastases remain. These mainly concern the radiation dose, need for a combination of RS and WBRT, relative timing of different treatment modalities, and maximum number of brain metastases that can reasonably be treated with RS when long-term progression-free survival is the goal. However, RS is definitely an excellent option for salvage and palliation in patients with short life expectancy, as it is simultaneously noninvasive and cost-effective, with short hospitalization times.
脑转移瘤的辅助治疗。
脑转移在普通人群中的发病率为15/10(5),是癌症患者严重的衰弱并发症。这些患者中的大多数患有不止一种转移,但高达30%至40%的患者表现为孤立病变。全脑放疗(WBRT)将中位生存期从仅使用类固醇治疗的1至2个月延长至大多数系列的4至6个月。然而,长期生存(bbb10 -2年)在高达10%的患者中观察到良好的预后因素,如孤立病变,良好的Karnofsky性能状态,无颅外疾病。对于这些患者,个体化的优化治疗是值得的。对于预后良好且颅外疾病得到控制的患者,应考虑手术联合术后WBRT,特别是在要求快速缓解症状的情况下。对于小于30立方厘米的孤立性病变,立体定向放射手术(RS)虽然从未以随机方式与手术进行比较,但似乎产生了可比较的结果,并且是在适当选择的患者中多种病变的治疗选择。然而,关于脑转移的最佳治疗方案仍然存在许多问题。这些主要涉及放疗剂量、RS和WBRT联合治疗的需要、不同治疗方式的相对时机,以及以长期无进展生存为目标时,RS可合理治疗的脑转移瘤的最大数量。然而,对于预期寿命较短的患者,RS绝对是挽救和缓解的绝佳选择,因为它同时是非侵入性的,具有成本效益,住院时间短。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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