Cancro al seno
With the advancement of breast cancer diagnosis and treatment, the survival time of breast cancer patients has prolonged significantly, but the incidence of breast cancer brain metastases (BCBM) has gradually increased. This article reviews recent clinical studies related to the survival prognosis and treatment of breast metastases from breast cancer. It is generally believed that factors such as age, KPS score, receptor status, number of brain metastases, and control of extracranial lesions affect patient prognosis. Surgery, whole brain radiotherapy (WBRT), and stereotactic radiosurgergy (SRS) are currently the first-line treatments for brain metastases. With the development of comprehensive cancro al seno treatment, the application of chemotherapy and molecular targeted therapy in breast metastasis has received more and more attention.
Metastasi cerebrali del cancro al seno
Negli ultimi anni, con il miglioramento continuo della diagnosi e del trattamento, il tempo di sopravvivenza dei pazienti si è prolungato in modo significativo e anche l'incidenza delle metastasi cerebrali (metastasi cerebrali, BM) è aumentata in modo significativo. Circa il 30% dei pazienti alla fine svilupperà metastasi cerebrali e il tempo di sopravvivenza dopo le metastasi cerebrali è di 2 ~ 14 mesi. Il cancro al seno ha un'alta incidenza di metastasi cerebrali e una prognosi sfavorevole. È diventato un fattore importante che influisce sulla qualità della vita e sulla sopravvivenza. La prognosi e il trattamento della BM è sempre stata al centro e alle difficoltà dei circoli accademici. È importante analizzare le sue caratteristiche cliniche e trovare trattamenti efficaci. E compito urgente. Questo articolo esamina la prognosi clinica e il trattamento del BCBM.
Fattori prognostici per metastasi cerebrali da cancro al seno
Alcuni studi hanno dimostrato che la prognosi del BCBM è correlata a fattori quali età, classificazione molecolare, metastasi extracraniche, numero di lesioni BM, area di lesione massima e punteggio KPS. I ricercatori hanno stabilito diversi modelli di valutazione prognostica basati sui suddetti fattori di influenza, cercando di distinguere in modo più efficace i pazienti con diverse metastasi cerebrali prognostiche per aiutare la scelta delle strategie cliniche.
Trattamento del carcinoma mammario metastatico cerebrale
Il trattamento delle metastasi cerebrali da cancro al seno deve essere valutato in modo completo sulla base di fattori quali le condizioni generali della paziente, la posizione della lesione e il controllo extracranico prima di decidere il piano di trattamento. Al momento, la chirurgia, la WBRT e la SRS sono ancora il trattamento di prima linea del BCBM. Sono stati compiuti progressi anche nella chemioterapia e nelle terapie molecolari mirate.
Terapia ormonale per carcinoma mammario metastatico
The commonly used drug is dexamethasone, and hormone therapy is not required for patients with asymptomatic brain metastases. Dexamethasone can relieve the symptoms caused by edema in a short time by restoring the elasticity of arterial blood vessels and reducing the permeability of capillaries. The recommended starting dose of dexamethasone is 4 ~ 8mg / d; when brain metastases are secondary to severe cerebral edema and high intracranial pressure, it is recommended to use dexamethasone at a dose of 16mg / d or greater, which should be gradually reduced when discontinued. the amount.
Trattamento chirurgico del carcinoma mammario metastatico
È adatto principalmente a pazienti con colpi singoli e KPS> 70. Clinicamente, il 20% -30% dei pazienti è adatto per il trattamento chirurgico. I suoi vantaggi sono che può alleviare rapidamente i sintomi, ottenere campioni patologici e migliorare il tasso di controllo locale. Lo stato della chirurgia in più metastasi cerebrali manca ancora di dati e conclusioni rilevanti.
Radioterapia dell'intero cervello
For patients with intracranial lesions> 3, the total effective rate of whole-brain radiotherapy alone was 60 to 80%. About 70% of patients had improved symptoms and prolonged the average survival time of 3 to 6 months. Stereotactic Radiosurgery (SRS)It is generally believed that SRS is mainly suitable for patients with 3 or less lesions, a diameter of <3.0 cm, and a small space effect, especially for tumors that are not easily accessible during surgery and are located in important functional areas. But SRS has been studied more and more in multiple brain metastases, and it seems feasible.
Chemioterapia per carcinoma mammario metastatico
The efficacy of chemotherapy on BCBM is limited because the drug has difficulty crossing the blood-brain barrier. Some studies in recent years have shown that the combination of chemotherapy and radiotherapy can improve the efficacy. Because radiation therapy opens the blood-brain barrier, drugs can enter the skull to exert anti-tumor effects. Although chemotherapeutic drugs are difficult to achieve a clear antitumor effect in the skull, effective control of extracranial lesions can improve the quality of life and prolong the survival time of patients.
Terapia mirata per il carcinoma mammario metastatico
With the continuous understanding of the mechanism of tumore formation and metastasis, molecular targeted therapy has become a routine treatment strategy for malignant tumors. Bevacizumab combined with radiotherapy is mainly used for the treatment of gliomi, and there are few studies in brain metastases such as breast cancer and lung cancer, and further research is still needed.
Terapia endocrina per carcinoma mammario metastatico
There is very little research data on endocrine therapy in BCBM treatment. Because endocrine therapy has a slower onset of action, and most patients with BM have a poor prognosis and need to control local symptoms as soon as possible, endocrine therapy is not recommended as first-line treatment for BCBM. In summary. The high incidence and poor prognosis of brain metastases in breast cancer have become clinically difficult problems. It is generally believed that factors such as age, KPS score, receptor status, number of brain metastases, and stability of extracranial lesions affect the prognosis of patients, but the current prognostic assessment model has limited predictive power and needs to be further improved and improved. In terms of treatment, surgery and radiation therapy are still the main treatment methods, and the status of chemotherapy and molecular targeted drugs has gradually increased.
