脑转移瘤的综合治疗

脑转移是目前肿瘤治疗的难点之一，既往治疗主要以全脑放疗为首选，但全脑放疗后疗效差以及明显影响治疗后长期存活患者的生活质量。所以脑转移的治疗应根据不同预后行个体化治疗。目前基于RTOG研究的Graded Prognostic Assessment评分在国内外广泛使用。对于GPA高的患者，建议采用积极的治疗手段，如全脑放疗联合手术或者立体定向放射治疗，部分患者可考虑使用手术联合立体定向放射治疗；对于GPA低的患者，仍以全脑放疗为首选,部分患者可考虑采用联合分子靶向药物治疗。考虑到全脑放疗的脑功能损伤与海马结构照射有关，越来越多研究开始探索全脑放疗中保护海马的新策略。

Multidisciplinary Treatment of Brain Metastases

The management of brain metastases （BM） is under controversy. Traditionally, whole-brain radiotherapy （WBRT） is the mainstay treatment for BM. However, the efficacy of WBRT is far from satisfactory and the quality of life （QOL） of patient with long survival is adversely influenced by WBRT. The treatment should be individually tailored in BM patients. According to Graded Prognostic Assessment （GPA） developed by RTOG, patients with high a GPA score are recommended to receive aggressive treatment such as WBRT combined with surgery or stereotactic radiotherapy, and surgery combined with stereotactic radiotherapy. For patients with low GPA score, WBRT with or without target therapy are recommended. Strategies to protect hippocampus in radiotherapy are currently under investigation.