多发脑转移瘤的放射治疗

多发脑转移瘤的放射治疗已经从上世纪80年代前的全脑放疗或最佳支持治疗逐渐发展到目前立体定向放疗广泛应用的时代。大量文献证实立体定向放疗联合全脑放疗较之单纯全脑放疗虽未提高患者的生存期,但可以改善多发脑转移瘤患者的颅内控制率,进而使患者的生活质量得到提高。近年随着人们对脑转移瘤患者认知功能的重视,有学者提出是否可以在脑转移瘤患者的首程治疗中省略全脑放疗。到目前为止共有4个随机分组研究对单纯立体定向放疗与立体定向放疗联合全脑放疗对患者认知功能以及生存的影响进行了较为深入的研究,其中3个已经有结果报道。目前的结论一致认为,省略全脑放疗后患者的颅内控制率显著降低,但挽救治疗后并未影响患者的总生存期,对这种治疗方式对脑转移瘤患者认知功能的影响其研究结果并不一致,还需积累更有说服力的数据。总之,目前多发脑转移瘤的治疗还缺乏统一的标准治疗模式,但对这部分患者的治疗越来越多的学者持有比较积极的态度。

Radiotherapy for Multiple Brain Metastasis

Brain metastases are the most common intra-cranial malignancy in adult,and an estimated 216 000 new patients were diagnosed with brain metastasis in American per year.Brain metastases now develop in approximately 15% of cancer patients in adult,especially those with lung cancer and breast cancer.Among the patients of brain metastasis,about 50% are with multiple brain metastases.Radiotherapy for multiple brain metastases includes the whole brain radiotherapy,stereotactic radiotherapy and the combination of the both strategies.In this article,we reviewed the current advance in radiotherapy of multiple brain metastases with the purpose to be helpful to the clinical practice.