脑转移瘤的立体定向放射治疗

Stereotactic Radiotherapy for Brain Metastases

单纯立体定向放射外科能取得全脑放疗联合立体定向外科治疗相同的生存率,对于局部控制来说,结果有冲突。全脑放疗较局部治疗（立体定向放射外科和手术）减少颅内新发病灶。单纯立体定向放射外科组颅内治疗病灶外以及颅内总体复发率均增加,而且联合全脑放疗不增加认知功能损伤。对于1-3个脑转移瘤患者,单纯立体定向放射外科生存好于单纯全脑放疗。全脑放疗联合立体定向外科治疗较全脑放疗能改善局部控制,并在不增加并发症的基础上改善KPS评分。对于单发脑转移灶,联合治疗有生存获益。但2个及2个以上的脑转移灶是否有生存优势,尚有争论。对于多发脑转移瘤、KPS〈70分的患者联合治疗能改善生存。全脑放疗联合立体定向外科治疗和手术联合全脑放射治疗两组无生存差异。

Stereotactic radiosurgery （SRS） alone achieves the same survival compared with SRS ＋ whole brain radiation therapy （WBRT）, but the results are conflicting for local control. WBRT lowers the risk of cranial distant recurrence compared to local tumor therapies （SRS and surgery）. SRS alone leads to a higher risk of either distant brain or overall brain recurrence, but preserves neurocognitive function when combined with WBRT. SRS alone improves the survival of patients with 1 -3 metastases compared to WBRT alone. SRS ＋ WBRT provides superior local control compared with WBRT, and also shows improved KPS score without increasing toxicity. SRS ＋ WBRT demonstrates a superior survival benefit for patients with single brain metastasis, but the survival advantage for patients with more than 2 metastases remains controversial. SRS ＋ WBRT shows similar survival to surgery ＋ WBRT.