Radiation therapy for older patients with brain tumors.
Radiation therapy for older patients with brain tumors.
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DOI：
10.1186/s13014-017-0841-9
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发表时间：
2017-06-19
期刊：
影响因子：
--
通讯作者：
Ricardi U
中科院分区：
文献类型：
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作者：
Minniti G;Filippi AR;Osti MF;Ricardi U
在过去的几十年里，老年人群中脑肿瘤的发病率有所增加。目前的治疗包括手术，放疗和化疗，但老年脑肿瘤患者的最佳管理仍然是一个争论的问题，因为在这个人群中积极的放射治疗可能与神经毒性和生活质量恶化的高风险相关。对于这些患者，仔细的临床状态评估对于临床决策和设计随机试验以充分评估放疗和化疗的最佳组合都是强制性的。几项随机研究已经证明了化疗对胶质母细胞瘤或淋巴瘤患者的疗效和安全性;然而，放疗联合化疗或作为挽救治疗仍然是一种与生存获益相关的有效治疗选择。立体定向技术越来越多地用于治疗脑转移瘤和良性肿瘤患者，包括垂体腺瘤、脑膜瘤和听神经瘤。尽管没有随机试验证明SRS在患有脑转移瘤或良性脑肿瘤的老年患者中优于其他放射技术，但从最近的随机研究和大型回顾性系列中提取的数据表明，SRS在此类患者中是一种有效的方法，其生存优势和毒性特征与在年轻人中观察到的相似。未来的试验需要研究老年脑肿瘤患者的最佳放射技术和剂量/分次方案，包括临床结局、神经认知功能和生活质量。
The incidence of brain tumors in the elderly population has increased over the last few decades. Current treatment includes surgery, radiotherapy and chemotherapy, but the optimal management of older patients with brain tumors remains a matter of debate, since aggressive radiation treatments in this population may be associated with high risks of neurological toxicity and deterioration of quality of life. For such patients, a careful clinical status assessment is mandatory both for clinical decision making and for designing randomized trials to adequately evaluate the optimal combination of radiotherapy and chemotherapy. Several randomized studies have demonstrated the efficacy and safety of chemotherapy for patients with glioblastoma or lymphoma; however, the use of radiotherapy given in association with chemotherapy or as salvage therapy remains an effective treatment option associated with survival benefit. Stereotactic techniques are increasingly used for the treatment of patients with brain metastases and benign tumors, including pituitary adenomas, meningiomas and acoustic neuromas. Although no randomized trials have proven the superiority of SRS over other radiation techniques in older patients with brain metastases or benign brain tumors, data extracted from recent randomized studies and large retrospective series suggest that SRS is an effective approach in such patients associated with survival advantages and toxicity profile similar to those observed in young adults. Future trials need to investigate the optimal radiation techniques and dose/fractionation schedules in older patients with brain tumors with regard to clinical outcomes, neurocognitive function, and quality of life.