Management of melanoma brain metastases: Evidence-based clinical practice guidelines by Cancer Council Australia
Management of melanoma brain metastases: Evidence-based clinical practice guidelines by Cancer Council Australia
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DOI：
10.1016/j.ejca.2020.10.013
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发表时间：
2021-01-01
影响因子：
8.4
通讯作者：
Long, Georgina, V
中科院分区：
文献类型：
--
作者：
Hong, Angela M.;Waldstein, Cora;Long, Georgina, V
前言：脑是晚期黑色素瘤患者常见的转移性疾病部位。脑转移预示着不良的预后，通常会导致神经功能和生活质量的恶化，并导致神经死亡。包括手术、放射治疗和系统治疗在内的治疗方法可以更好地控制这一问题。因此，需要为黑色素瘤脑转移的管理制定适当的指南，并在新的治疗方案出现时定期更新。方法：由澳大利亚癌症委员会建立的多学科工作小组为黑色素瘤的管理制定了最新的、基于证据的临床实践指南。在选择了关键的临床问题后，对相关研究进行了全面的文献搜索，然后对这些研究进行了系统的综述。总结了数据并评估了证据，从而制定了建议。主要建议：如果可能，最好用手术治疗症状性病变；这提供了安全和有效的局部控制。对于单个或少量无症状性脑转移瘤的患者，建议采用立体定向放射治疗，但对于此前未接受过系统治疗的无症状患者，可考虑将药物治疗作为一线治疗方案。全脑放射治疗可能为多发性脑转移瘤患者提供姑息治疗的益处。只要有可能，有脑转移的黑色素瘤患者应该由黑色素瘤专家组成的多学科团队进行管理，该团队考虑手术、放射治疗和系统治疗的最佳组合和顺序。皇冠版权所有(C)2020由爱思唯尔有限公司出版。保留所有权利。
Introduction: The brain is a common site of metastatic disease for patients with advanced melanoma. Brain metastasis portends a poor prognosis, often causing deterioration in neurological function and quality of life, and leading to neurological death. Treatment approaches including surgery, radiotherapy and systemic therapy can lead to better control of this problem. Therefore, appropriate guidelines for the management of melanoma brain metastases need to be established, with regular updating when new treatment options become available.Methods: A multidisciplinary working party established by Cancer Council Australia has produced up-to-date, evidence-based clinical practice guidelines for the management of melanoma. After selecting key clinical questions, a comprehensive literature search for relevant studies was conducted, followed by systematic review of those studies. Data were summarised and the evidence was assessed, leading to the development of recommendations.Main recommendations: Symptomatic lesions are best treated with surgery, when possible; this provides safe and effective local control. For patients with single or a small number of asymptomatic brain metastases, stereotactic radiotherapy is recommended, but in asymptomatic patients who have not previously received systemic treatment, drug therapy can be considered as a first-line treatment option. Whole brain radiotherapy may provide palliative benefits in patients with multiple brain metastases. Whenever possible, melanoma patients with brain metastases should be managed by a multidisciplinary team of melanoma specialists that considers the optimal combination and sequencing of surgery, radiotherapy and systemic therapy. Crown Copyright (C) 2020 Published by Elsevier Ltd. All rights reserved.