Novel insights into the management of brain metastases
Novel insights into the management of brain metastases
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DOI：
10.1097/wco.0b013e32833f8cb5
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发表时间：
2010-12-01
影响因子：
4.8
通讯作者：
Mehta, Minesh P.
中科院分区：
文献类型：
--
作者：
Gondi, Vinai;Mehta, Minesh P.
综述目的本综述提供了有关当前治疗的可用临床证据，讨论了持续存在的争议，并介绍了脑转移治疗的研究方法。最新发现估计脑转移患者预后的新方法强调了针对每个特定患者制定治疗方案的重要性。在预后不良的情况下，临终关怀、症状管理或短程全脑放疗 (WBRT) 是姑息治疗的关键组成部分。在预后良好或中等的情况下，治疗选择可以包括稍微延长疗程的全脑放疗、手术、立体定向放射外科、全身治疗或组合治疗。适当治疗的选择受到脑转移数量、患者总体表现状态和剩余预期寿命以及对每种治疗方式的益处和毒性的了解的影响。最近的临床研究对 WBRT 后记忆变化的时间顺序提供了新的见解。目前正在研究减轻这些辐射引起的记忆效应的创新方法。摘要脑转移的循证治疗代表了活跃临床研究的一个不断发展的领域。除了颅内肿瘤控制和生存等常规结果外，正在进行和未来的研究重点是维持认知和生活质量。
Purpose of reviewThis review provides available clinical evidence regarding current therapies, discusses ongoing controversies, and introduces investigational approaches in the management of brain metastases.Recent findingsNovel approaches to estimating prognosis of patients with brain metastases highlight the importance of tailoring treatment to each particular patient. In the setting of unfavorable prognosis, either hospice care, symptom management, or short-course whole-brain radiotherapy (WBRT) is a critical component of palliation. In the setting of favorable or intermediate prognosis, treatment options can include a slightly more prolonged course of WBRT, surgery, stereotactic radiosurgery, systemic therapy, or a combination. Selection of the appropriate treatment is influenced by the number of brain metastases, overall patient performance status and residual life expectancy, as well as an understanding of the benefits and toxicities of each modality. Recent clinical studies have shed novel insight on the temporal sequence of memory changes following WBRT. Innovative approaches to mitigating these radiation-induced memory effects are currently being investigated.SummaryEvidence-based management of brain metastases represents an evolving field of active clinical research. Ongoing and future investigations focus on the preservation of cognition and quality of life, in addition to conventional outcomes such as intracranial tumor control and survival.