Brystkreft
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 brystkreft treatment, the application of chemotherapy and molecular targeted therapy in breast metastasis has received more and more attention.
Hjernemetastase av brystkreft
De siste årene, med kontinuerlig forbedring av diagnose og behandling, har pasientens overlevelsestid forlenget seg betydelig, og forekomsten av hjernemetastaser (hjernemetastase, BM) har også økt betydelig. Omtrent 30% av pasientene vil etter hvert utvikle hjernemetastaser, og overlevelsestiden etter hjernemetastaser er 2 ~ 14 måneder. Brystkreft har høy forekomst av hjernemetastase og dårlig prognose. Det har blitt en viktig faktor som påvirker livskvalitet og overlevelse. Prognosen og behandlingen av BM har alltid vært fokus og vanskeligheter for akademiske kretser. Det er viktig å analysere dets kliniske egenskaper og finne effektive behandlinger. Og presserende oppgave. Denne artikkelen gjennomgår den kliniske prognosen og behandlingen av BCBM.
Prognostiske faktorer for hjernemetastaser fra brystkreft
Noen studier har vist at prognosen for BCBM er relatert til faktorer som alder, molekylær klassifisering, ekstrakraniell metastase, antall BM-lesjoner, maksimalt lesjonsareal og KPS-score. Forskere har etablert forskjellige prognostiske evalueringsmodeller basert på ovennevnte påvirkningsfaktorer, og prøver å mer effektivt skille pasienter med forskjellige prognostiske hjernemetastaser for å hjelpe valget av kliniske strategier.
Behandling av metastatisk brystkreft i hjernen
Behandlingen av hjernemetastaser fra brystkreft må vurderes grundig basert på faktorer som pasientens generelle tilstand, lesjonens plassering og ekstrakraniell kontroll før behandlingsplanen avgjøres. For tiden er kirurgi, WBRT og SRS fremdeles førstelinjebehandling av BCBM. Det er også gjort fremskritt innen cellegift og molekylær målrettet behandling.
Hormonbehandling for metastatisk brystkreft
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.
Kirurgisk behandling av metastatisk brystkreft
Det er hovedsakelig egnet for pasienter med enkeltskudd og KPS> 70. Klinisk er 20% -30% av pasientene egnet for kirurgisk behandling. Fordelene er at det raskt kan lindre symptomer, få patologiske prøver og forbedre lokal kontrollrate. Status for kirurgi i flere hjernemetastaser mangler fortsatt relevante data og konklusjoner.
Hele hjernens strålebehandling
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.
Kjemoterapi for metastatisk brystkreft
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.
Målrettet terapi for metastatisk brystkreft
With the continuous understanding of the mechanism of svulst 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 hjernesvulst, and there are few studies in brain metastases such as breast cancer and lung cancer, and further research is still needed.
Endokrin terapi for metastatisk brystkreft
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.
