Stereotactic radiosurgery (SRS) in the modern management of patients with brain metastases.
Stereotactic radiosurgery (SRS) in the modern management of patients with brain metastases.
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DOI：
10.18632/oncotarget.7131
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发表时间：
2016-03-15
期刊：
影响因子：
--
通讯作者：
Sahgal A
中科院分区：
文献类型：
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作者：
Soliman H;Das S;Larson DA;Sahgal A
立体定向放射外科（SRS）是一种已确立的脑转移瘤的非侵入性消融治疗。SRS的早期临床试验证明，肿瘤控制率上级单纯全脑放疗（WBRT）。因此，WBRT加SRS被广泛用于脑转移瘤数量有限的患者（“有限数量”通常意味着1-4）。随后的试验集中在回答WBRT是否有必要提前。根据当前的随机对照试验（RCT）和比较SRS单独与SRS + WBRT的荟萃分析，辅助WBRT可获得更好的颅内控制;但是，以神经认知功能和生活质量为代价。WBRT的这些不良反应也可能对年轻患者的生存产生负面影响。根据这些研究的结果，转移灶数量有限的患者的治疗已转向单独使用SRS。此外，随机对照试验正在评估SRS单独在>4个脑转移瘤患者中的作用。SRS的新发展包括用于大肿瘤的分次SRS以及SRS与穿过血脑屏障和/或刺激免疫反应的靶向全身治疗的整合。我们在这篇综述中介绍了目前支持SRS作为有限脑转移患者的标准治疗的高水平证据和理由，以及SRS的新兴应用。
Stereotactic radiosurgery (SRS) is an established non-invasive ablative therapy for brain metastases. Early clinical trials with SRS proved that tumor control rates are superior to whole brain radiotherapy (WBRT) alone. As a result, WBRT plus SRS was widely adopted for patients with a limited number of brain metastases (“limited number” customarily means 1-4). Subsequent trials focused on answering whether WBRT upfront was necessary at all. Based on current randomized controlled trials (RCTs) and meta-analyses comparing SRS alone to SRS plus WBRT, adjuvant WBRT results in better intracranial control; however, at the expense of neurocognitive functioning and quality of life. These adverse effects of WBRT may also negatively impact on survival in younger patients. Based on the results of these studies, treatment has shifted to SRS alone in patients with a limited number of metastases. Additionally, RCTs are evaluating the role of SRS alone in patients with >4 brain metastases. New developments in SRS include fractionated SRS for large tumors and the integration of SRS with targeted systemic therapies that cross the blood brain barrier and/or stimulate an immune response. We present in this review the current high level evidence and rationale supporting SRS as the standard of care for patients with limited brain metastases, and emerging applications of SRS.