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20%~40%的恶性肿瘤患者在其自然病程中会出现肿瘤的脑转移,其中50%以上为多发脑转移[1]。近年来脑转移瘤发病率呈上升趋势,分析原因可能与肿瘤患者的总体生存期延长以及影像学技术的发展有关。脑转移瘤的症状进展迅速,不治者生存期不超过3个月[2]。
放射治疗作为脑转移瘤最为重要的姑息治疗手段,可在有效地改善脑转移瘤患者生活质量的同时延长生存期,但目前对其具体放疗方案(照射范围、最佳剂量及分割方式)仍存较大争议。本文将对转移瘤的放射治疗进展予以综述,同时探讨放疗方案的选择。
脑转移瘤的放射治疗进展
Advances in radiotherapy of brain metastases
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摘要: 脑转移瘤是肿瘤最常见的神经系统并发症,发病率呈上升趋势。治疗方案已经从传统的全脑放射治疗发展到个体化治疗阶段。放疗仍是当前的主要治疗手段之一。随着放疗技术的不断发展,脑转移瘤患者的生活质量明显改善,生存期明显延长。全脑放疗、立体定向放射外科以及两者联合是目前的主要治疗方法,但在最佳联合方式及患者的选择等方面尚待进一步明确。笔者将对脑转移瘤的放射治疗进展进行综述。Abstract: Brain metastases are the most common neurologic complication related to systemic cancer and the incidence is expected to increase. Treatment of metastatic brain tumors streamlined from empirical whole brain irradiation to aggressive personalized treatment. Radiotherapy is one of the main treatment modalities. With the development of radiotherapy techniques, the quality of life and survival of patients with brain metastases have been significantly improved. Whole brain radiotherapy, stereotactic radiosurgery as well as the combination is the main treatment options, but the best combination method and suitable patients need to be further investigated. The article reviewed the advances in radiotherapy of brain metastases.
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Key words:
- Brain neoplasms /
- Radiotherapy /
- Radiotherapy dosage /
- Stereotactic radiosurgery
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[1] 殷蔚伯, 余子豪, 徐国镇, 等.肿瘤放射治疗学(第四版)[M].北京: 中国协和医科大学出版社, 2008: 1200.
[2] 郭阳, 姜炜, 张文学, 等.立体定向放射治疗脑转移瘤疗效分析[J].国际放射医学核医学杂志. 2007, 31(2):122-124.
[3] Eichler AF, Loeffler JS. Multidisciplinary management of brain Metastases[J]. Oncologist, 2007, 12(7):884-898. [4] Borgelt B, Gelber R, Kramer S, et al. The palliation of brain metastases:final results of the first two studies by the Radiation Therapy Oncology Group[J]. Int J Radiat Oncol Biol Phys, 1980, 6(1):1-9. [5] Deangelis LM, Delattre JY, Posner JB. Radiation-induced dementia in patients cured of brain metastases[J]. Neurology, 1989, 39(6):789-796. [6] Meyer A, Steinmann D, Malaimare L, et al. Prediction of prognosis regarding fractionation schedule and survival in patients with whole-brain radiotherapy for metastatic disease[J]. Anticancer Res, 2009, 28(6B):3965-3969. [7] Tsao MN, Lloyd N, Wong RK, et al. Whole brain radiotherapy for the treatment of newly diagnosed multiple brain metastases[J/OL]. Cochrane Database Syst Rev, 2012, 4: CD003869[2015-03-29]. http://www. ncbi. nlm. nih. gov/pubmed/22513917. [8] Lee YW, Cho HJ, Lee WH, et al. Whole brain radiation-induced cognitive impairment:pathophysiological mechanisms and therapeutic targets[J]. Biomol Ther(Seoul), 2012, 20(4):357-370. [9] Gondi V, Hermann BP, Mehta MP, et al. Hippocampal dosimetry predicts neurocognitive function impairment after fractionated stereotactic radiotherapy for benign or low-grade adult brain tumors[J/OL]. Int J Radiat Oncol Biol Phys, 2012, 83(4): e487-e493[2015-03-29]. http://www.ncbi.nlm.nih.gov/pubmed/22209148. [10] Gondi V, Pugh SL, Tome WA, et al. Preservation of memory with conformal avoidance of the hippocampal neural stem-cell compartment during whole-brain radiotherapy for brain metastases(RTOG 0933):a phase Ⅱ multi-institutional trial[J]. J Clin Oncol, 2014, 32(34):3810-3816. [11] Harth S, Abo-Madyan Y, Zheng L, et al. Estimation of intracranial failure risk following hippocampal-sparing whole brain radiotherapy[J]. Radiother Oncol, 2013, 109(1):152-158. [12] Patchell RA, Tibbs PA, Regine WF, et al. Postoperative radiotherapy in the treatment of single metastases to the brain:a randomized trial[J]. JAMA, 1998, 280(17):1485-1489. [13] Mcpherson CM, Suki D, Feiz-Erfan I, et al. Adjuvant whole-brain radiation therapy after surgical resection of single brain metastases[J]. Neuro Oncol, 2010, 12(7):711-719. [14] Gaspar LE, Mehta MP, Patchell RA, et al. The role of whole brain radiation therapy in the management of newly diagnosed brain metastases:a systematic review and evidence-based clinical practice guideline[J]. J Neurooncol, 2010, 96(1):17-32. [15] Stark AM, Stöhring C, Hedderich J, et al. Surgical treatment for brain metastases:Prognostic factors and survival in 309 patients with regard to patient age[J]. J Clin Neurosci, 2011, 18(1):34-38. [16] Sanghavi SN, Miranpuri SS, Chappell R, et al. Radiosurgery for patients with brain metastases:a multi-institutional analysis, stratified by the RTOG recursive partitioning analysis method[J]. Int J Radiat Oncol Biol Phys, 2001, 51(2):426-434. [17] Andrews DW, Scott CB, Sperduto PW, et al. Whole brain radiation therapy with or without stereotactic radiosurgery boost for patients with one to three brain metastases:phase Ⅲ results of the RTOG 9508 randomised trial[J]. Lancet, 2004, 363(9422):1665-1672. [18] Assouline A, Levy A, Chargari C, et al. Whole brain radiotherapy:prognostic factors and results of a radiation boost delivered through a conventional linear accelerator[J]. Radiother Oncol, 2011, 99(2):214-217. [19] Bauman G, Yartsev S, Fisher B, et al. Simultaneous infield boost with helical tomotherapy for patients with 1 to 3 brain metastases[J]. Am J Clin Oncol, 2007, 30(1):38-44. [20] Rodrigues G, Yartsev S, Yaremko B, et al. Phase I trial of simultaneous in-field boost with helical tomotherapy for patients with one to three brain metastases[J]. Int J Radiat Oncol Biol Phys, 2011, 80(4):1128-1133. [21] Zhou L, Liu J, Xue J, et al. Whole brain radiotherapy plus simultaneous in-field boost with image guided intensity-modulated radiotherapy for brain metastases of non-small cell lung cancer[J/OL]. Radiat Oncol, 2014, 9: 117[2015-03-29]. http://www. ncbi. nlm. nih. gov/pubmed/24884773. [22] Bindal AK, Bindal RK, Hess KR, et al. Surgery versus radiosurgery in the treatment of brain metastasis[J]. J Neurosurg, 1996, 84(5):748-754. [23] Schöggl A, Kitz K, Reddy M, et al. Defining the role of stereotactic radiosurgery versus microsurgery in the treatment of single brain metastases[J]. Acta Neurochir(Wien), 2000, 142(6):621-626. [24] Choi CY, Chang SD, Gibbs IC, et al. Stereotactic radiosurgery of the postoperative resection cavity for brain metastases:prospective evaluation of target margin on tumor control[J]. Int J Radiat Oncol Biol Phys, 2012, 84(2):336-342. [25] Aoyama H, Shirato H, Tago M, et al. Stereotactic radiosurgery plus whole-brain radiation therapy vs stereotactic radiosurgery alone for treatment of brain metastases:a randomized controlled trial[J]. JAMA, 2006, 295(21):2483-2491. [26] Kocher M, Soffietti R, Abacioglu U, et al. Adjuvant whole-brain radiotherapy versus observation after radiosurgery or surgical resection of one to three cerebral metastases:results of the EORTC 22952-26001 study[J]. J Clin Oncol, 2011, 29(2):134-141. [27] Rades D, Huttenlocher S, Hornung D, et al. Do patients with very few brain metastases from breast cancer benefit from whole-brain radiotherapy in addition to radiosurgery?[J/OL]. Radiat Oncol, 2014, 9: 267[2015-03-29]. http://www. ncbi. nlm. nih. gov/pubmed/25472758.
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