Epidemiology, Treatment, and Complications of Central Nervous System Metastases.
Epidemiology, Treatment, and Complications of Central Nervous System Metastases.
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DOI：
10.1212/con.0000000000000551
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发表时间：
2017-12-01
期刊：
影响因子：
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通讯作者：
Pruitt, Amy A
中科院分区：
文献类型：
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作者：
Pruitt, Amy A
审查目的：由全身性癌症转移到脑实质、硬脑膜、脊髓和软脑膜引起的神经系统问题是神经科医生最常见的会诊类型。随着患者从全身性癌症中存活更长时间，沿着快速发展的治疗选择，这些毁灭性并发症的治疗变得更加有效和复杂。本文综述了转移性疾病的当前模式以及不断发展的治疗方法、其并发症及其对生存质量的影响。使用酪氨酸激酶抑制剂和免疫检查点抑制剂的靶向治疗以及针对疾病特异性化学敏感性模式的细胞毒性治疗显著改善了非小细胞肺癌、黑色素瘤和乳腺癌的预后，但导致了一些新的并发症和改变的复发模式。临床试验表明，在全脑放射治疗中，避免遮挡辐射场和立体定向放射外科的使用具有优越性，可最大限度地减少放射治疗的长期认知后果。新出现的数据记录了脑放射与免疫治疗相结合时的可耐受安全性。化疗可以作为一些不能手术的脑转移瘤的一线治疗，消除或推迟全脑放射治疗。立体定向体部放射治疗是一种新的放射技术，用于脊柱和硬膜外转移，保留脊髓组织，同时消融tumors.SUMMARY：转移到神经系统仍然是毁灭性的，但他们的预后和治疗比以前认识到的更异质性。神经科医生现在可以根据新的分层标准提供更个性化的预后信息，可以预测与神经系统相关的药物并发症，并可以在多学科努力中提供重要的合作伙伴关系，以平衡有效的长期疾病控制与治疗相关的不良后果。
PURPOSE OF REVIEW: Neurologic problems resulting from systemic cancer metastases to brain parenchyma, dura, spinal cord, and leptomeninges are among the most common types of consultations addressed by neurologists. With patients surviving longer from systemic cancer, along with the rapidly evolving therapeutic options, the treatment of these devastating complications has become both more effective and more complicated. This article reviews current patterns of metastatic disease and the increasingly nuanced landscape of evolving therapies, their complications, and their impact on quality of survival.RECENT FINDINGS: Targeted therapies with tyrosine kinase inhibitors and immune checkpoint inhibitors and cytotoxic therapies directed at disease-specific chemosensitivity patterns have dramatically improved the prognosis of non-small cell lung cancer, melanoma, and breast cancer, but have led to some novel complications and altered recurrence patterns. Clinical trials suggest the superiority of hippocampal-avoidance radiation fields and the use of stereotactic radiosurgery over whole-brain radiation therapy to minimize long-term cognitive consequences of radiation therapy. Emerging data document tolerable safety when brain radiation is combined with immunotherapy. Chemotherapy can be a first-line treatment for some inoperable brain metastases, eliminating or deferring whole-brain radiation therapy. Stereotactic body radiation therapy is a new technique of radiation used for spinal and epidural metastases that spares spinal cord tissue while ablating tumors.SUMMARY: Metastases to the nervous system remain devastating, but their prognosis and therapies are more heterogeneous than previously appreciated. Neurologists now can offer more personalized prognostic information based on new stratification criteria, can predict drug complications relevant to the nervous system, and can provide critical partnership in the multidisciplinary effort to balance effective longer-term disease control with treatment-related adverse consequences.