难治性脑转移瘤的立体定向放射外科治疗策略及进展

脑转移瘤是发病率高、临床治疗难度大且预后较差的颅内常见恶性疾病，特别是其中的难治性脑转移瘤（大体积、多发、复发的转移瘤）常规治疗难以达到理想预后。立体定向放射外科（SRS）与常规治疗方式相比具有精准度高、单次照射剂量大、对周围组织损伤低等优势，已逐渐成为脑转移瘤患者治疗的首选方案。SRS治疗难治性脑转移瘤具有较好的效果，可有效抑制肿瘤增殖，提高患者的生活质量。SRS联合手术、化疗、分子靶向治疗及免疫治疗等方案可以提高难治性脑转移瘤患者的肿瘤局部控制率，但是否改善患者的预后尚存在争议，且联合治疗的不良反应也应引起关注。因此，本文就SRS治疗难治性脑转移瘤的治疗效果及联合治疗的策略及进展等方面进行文献报道综述。

Strategies and progresses of stereotactic radiosurgery for intractable brain metastases

Brain metastases are common intracranial diseases featured with high incidence rate, difficult clinical treatment and poor prognosis. Especially for refractory brain metastases (large volume, multiple recurrence and metastatic tumors), it is difficult for conventional therapies to achieve ideal prognosis. Compared with conventional therapies, stereotactic radiosurgery (SRS) has the advantages of high accuracy, large fractional dose and low damage to the surrounding tissues, and has gradually become the primary choice for the treatment of brain metastases. SRS has a good effect in the treatment of refractory brain metastases, and can effectively inhibit tumor proliferation and improve the quality of life of patients. SRS combined with surgery, chemotherapy, molecular targeted therapy and immunotherapy can improve the local tumor control rate of patients with intractable brain metastasis, but whether it can improve the prognosis of patients is still controversial. The adverse reactions of combined therapies should also be concerned. Therefore, this article reviews the therapeutic effects of SRS in the treatment of refractory brain metastases, the strategies and progresses of combined treatment.