Importance

Brain metastasis (BM) is the most common malignant intracranial neoplasm in adults with over 100,000 new cases annually in the United States and outnumbering primary brain tumors 10:1.

Observations

The incidence of BM in adult cancer patients ranges from 10-40%, and is increasing with improved surveillance, effective systemic therapy, and an aging population. The overall prognosis of cancer patients is largely dependent on the presence or absence of brain metastasis, and therefore, a timely and accurate diagnosis is crucial for improving long-term outcomes, especially in the current era of significantly improved systemic therapy for many common cancers. BM should be suspected in any cancer patient who develops new neurological deficits or behavioral abnormalities. Gadolinium enhanced MRI is the preferred imaging technique and BM must be distinguished from other pathologies. Large, symptomatic lesion(s) in patients with good functional status are best treated with surgery and stereotactic radiosurgery (SRS). Due to neurocognitive side effects and improved overall survival of cancer patients, whole brain radiotherapy (WBRT) is reserved as salvage therapy for patients with multiple lesions or as palliation. Newer approaches including multi-lesion stereotactic surgery, targeted therapy, and immunotherapy are also being investigated to improve outcomes while preserving quality of life.

Conclusion

With the significant advancements in the systemic treatment for cancer patients, addressing BM effectively is critical for overall survival. In addition to patient's performance status, therapeutic approach should be based on the type of primary tumor and associated molecular profile as well as the size, number, and location of metastatic lesion(s).

中文翻译：

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脑转移：临床管理多学科方法的更新

重要性

脑转移 (BM) 是成人中最常见的恶性颅内肿瘤，在美国每年有超过 100,000 例新病例，与原发性脑肿瘤的比例为 10:1。

观察

BM 在成年癌症患者中的发病率为 10-40%，并且随着监测的改进、有效的全身治疗和人口老龄化而增加。癌症患者的总体预后在很大程度上取决于是否存在脑转移，因此，及时准确的诊断对于改善长期预后至关重要，尤其是在当前许多常见癌症的全身治疗得到显着改善的时代。任何出现新的神经功能障碍或行为异常的癌症患者都应怀疑 BM。钆增强 MRI 是首选的成像技术，必须将 BM 与其他病变区分开来。功能状态良好的患者的大的、有症状的病变最好通过手术和立体定向放射外科 (SRS) 治疗。由于神经认知副作用和提高癌症患者的总体生存率，全脑放疗 (WBRT) 被保留作为多发性病变患者的挽救疗法或姑息治疗。还正在研究包括多病灶立体定向手术、靶向治疗和免疫治疗在内的更新方法，以改善结果，同时保持生活质量。

结论

随着癌症患者全身治疗的显着进步，有效解决 BM 对于总体生存至关重要。除了患者的体能状态外，治疗方法还应基于原发肿瘤的类型和相关的分子特征以及转移灶的大小、数量和位置。