脑转移瘤的放射治疗（简介）

一、脑转移瘤介绍

1.脑转移瘤原发疾病中最常见是肺癌、乳腺癌和黑色素瘤，也包括少部分结直肠癌及肾癌^[1]。

2.脑转移瘤患者的治疗不仅要关注总生存率，局部控制率以及颅内远处转移控制率保证患者神经功能状态以及患者生活质量也尤为重要^[2-3]。

3.目前对于脑转移瘤患者的积极治疗手段主要是：手术治疗和放射治疗。

4.放疗方式主要有:立体定向放射外科(SRS)及全脑放疗(WBRT)。

（1）立体定向放射外科（SRS）是一种高度精确的局部治疗主要优点，如治疗时间短、病变控制的可能性高、在常规的剂量/体积使用下及对正常组织的毒副作用较低。其不良反应主要有恶心呕吐、听力下降、皮肤反应、中枢神经损害、周围神经损害及其他不典型症状^[4]。

（2）立体定向放射外科的早期毒性反应发生率高，多数可以自行缓解，晚期毒性反应则明显低于单用全脑放射治疗或两者联合^[5]。

二、脑转移瘤的数目

1.美国放射肿瘤学协会(ASTRO)在2005年发表了一份针对脑转移瘤中SRS作用的报告，其中建议对转移瘤数目不超过4个，直径≤4cm的脑转移瘤可使用立体定向放射外科（SRS）^[6]。

2.目前已经被证实在＜4个脑转移灶时应用较单纯手术^[7]，单纯全脑放疗^[8], SRS+WBRT均有优势。

3.随看SRS的进展，SRS开始在多个脑转移灶的患者中初步探索，对比SRS应用于1-4个转移灶与＞5个转移灶的研究，证实了两者疗效及毒副反应均无明显差别，多个转移灶应用SRS安全有效^[10]。

4.结合现有结果及毒副反应情况，预期结果倾向于SRS相比WBRT更适合4-10个脑转移灶患者^[11]。

三、结论

SRS是一种高度精确的脑转移瘤的局部治疗方法，可适用于多个脑转移瘤，安全且疗效好，不良反应少。

参考文献：

1.PAUL W. SPERDUTO, et al.Diagnosis-specific prognostic factors, indexes, and treatme nt outcomes for patients with?newly diagnosed brain metastases: a muti-institutional analysis of 4,259 patients. Int J Radiat Oncol Biol Phys, 2010,77(3):655-661.

2.Ruda R, Franchino F, Soffietti R. Treatment of brain metastasis:current status and future directions. Curr Opin Oncol,2016, 28(6);:502-510.

3.Peters s, Bexelius C, Munk V, et al. The impact of brain metastasis on quality of life, resource tilization and survival in?patients with non-small-cell lung cancer. Cancer Treat Rev, 2016, 45: 139-162.

4.Sneed PK. Mendez J, Vemer-van den Hoek JG, et al. Adverse radiation effect after stereotactic radiosurgeryfor brain?metastases:incidence, time course, and risk factors. J Neurosurg, 2015, 123(2):373-386.

5.Sneed PK, Mendez J, Vemer-van den Hoek JG, et al. Adverse radiation effect after stereotactic radiosurgery for brain?metastase s:incidence, time course, and risk factors. J Neurosurg, 2015, 123(2):373-386.

6.Mehta MP, Tsao MN, WhelanTJ, et al. The American society for therapeutic radiology and oncology ( ASTRO )?evidence -based review of the role of radiosurgery for brain metastases(J). Int JR adiat Oncol Biol Phys, 2005， 63: 37.

7.Qin H, Wang C, Jiang Y, et al. Patients with single brain metastasis from non-small cell lung cancer equally benefit from?stereotactic radiosurgery and surgery: a systematic review. Med Sci Monit,2015, 21: 144-152.

8.Khan M, Lin J, Liao G, et al. Comparison of WBRT alone, SRS alone, and their combination in the treatment of one ormore brain metastases: review and meta-analysis. Tumour Biol, 2017, 39(7):1010428317702903.

9.Brown PD, Jaeckle K, Ballman KV, et al. Effect of radiosurgery alone vs radiosurgery with whole brain radiation therapy?on a randomized clinical trial. JAMA 2016, 316(4): 401-409.

10. Yamamoto M, Kawabe T, Sato Y, et al. A case-matched study of stereotactic radiosurgery for patients with?multiple brain metastases: comparing treatment results for 14 vs 25 tumors:clinical article. J Neurosurg,2013, 118(6): 1258-1268.

11. Zindler JD, Bruynzeel AME, Eekers DBP, et al. Whole brain radiotherapy versus stereotactic radiosurgery for 4-10 brain metastases: a phase m randomised multicentre trial. BMC Cancer,2017, 17(1): 500.