Epidemiology, Treatment, and Complications of Central Nervous System Metastases.

摘要: PURPOSE OF REVIEW Neurologic problems resulting from systemic cancer metastases to brain parenchyma, dura, spinal cord, and leptomeninges are among the most common types of consultations addressed by neurologists. With patients surviving longer cancer, along with rapidly evolving therapeutic options, treatment these devastating complications has become both more effective complicated. This article reviews current patterns metastatic disease increasingly nuanced landscape therapies, their complications, impact on quality survival. RECENT FINDINGS Targeted therapies tyrosine kinase inhibitors immune checkpoint cytotoxic directed at disease-specific chemosensitivity have dramatically improved prognosis non-small cell lung melanoma, breast but led some novel altered recurrence patterns. Clinical trials suggest superiority hippocampal-avoidance radiation fields use stereotactic radiosurgery over whole-brain therapy minimize long-term cognitive consequences therapy. Emerging data document tolerable safety when is combined immunotherapy. Chemotherapy can be a first-line for inoperable metastases, eliminating or deferring Stereotactic body new technique used epidural that spares cord tissue while ablating tumors. SUMMARY Metastases nervous system remain devastating, heterogeneous than previously appreciated. Neurologists now offer personalized prognostic information based stratification criteria, predict drug relevant system, provide critical partnership in multidisciplinary effort balance longer-term control treatment-related adverse consequences.