Radioterapia no tratamento das metástases cerebrais

Resumo

As metástases cerebrais representam o tumor mais comum do sistema nervoso central, superando substancialmente a incidência de tumores cerebrais primários. Estima-se que 20–40% dos pacientes oncológicos vão apresentar tal diagnóstico ao longo de sua evolução, com consequente piora da qualidade de vida e do prognóstico, sendo consideradas, portanto, problema de saúde pública. Uma vez feito o diagnóstico, o tratamento é composto por medidas sintomáticas e/ou medidas específicas. Entre as medidas específicas, listam-se: radioterapia, neurocirurgia e quimioterapia. Com o objetivo de elucidar o manejo radioterápico das metástases cerebrais e sua devida importância é que propomos esta revisão sobre o assunto.

Abstract

Brain metastasis represent the most common Central Nervous System tumor, much more frequent than primary brain tumors. It is estimated that 20–40% of oncologic patients will present this diagnosis during their disease progression, with decreased quality of life and worse prognosis, therefore it can be considered a public health problem. Once the diagnostic has been done, the treatment will be composed by symptomatics measures and/or specialized treatments, which can be listed: radiotherapy, neurosurgery and chemotherapy. This article aim to study brain metastasis radiotherapy treatment and its important role.

Palavras-chave

radioterapia - radiocirurgia - metástase neoplásica

Keywords

radiotherapy - radiosurgery - neoplasm metastasis

• Referências

• 1 De Vita Jr VT, Hellman S, Rosenberg SA. Principle and practice of oncology. 6^a ed. Philadelphia: Lippincott Williams & Wilkins; 2001
• 2 Kwok Y, Patchell RA, Regine WF. Palliation of brain and spinal cord metastases. In: Halperin EC, Perez CA, Brady LW. Principles and practice of radiation oncology. 5^a ed. Philadelphia: Lippincott Williams & Wilkins; 2008: 1974-1985
• 3 Weltman E, Brandt RA. Algoritimo para o tratamento das metastases cerebrais. Einstein 2008; 6: 89-91
• 4 Gaspar L, Scott C, Rotman M , et al. Recursive partitioning analysis (RPA) of prognostic factors in three Radiation Therapy Oncology Group (RTOG) brain metastases trials. Int J Radiat Oncol Biol Phys 1997; 37 (4) 745-751
• 5 Alexander 3rd E, Moriarty TM, Davis RB , et al. Stereotactic radiosurgery for the definitive, noninvasive treatment of brain metastases. J Natl Cancer Inst 1995; 87 (1) 34-40
• 6 Karnofsky DA, Burchenal JH. The clinical evaluation of chemotherapeutic agentes in cancer. In: MacLeod CM. Evaluation of Chemotherapeutic agentes. New York: Columbia University Press; 1949: 191-205
• 7 Breneman JC, Warnick RE, Albright Jr RE , et al. Stereotactic radiosurgery for the treatment of brain metastases. Results of a single institution series. Cancer 1997; 79 (3) 551-557
• 8 Glantz MJ, Cole BF, Forsyth PA , et al. Practice parameter: anticonvulsant prophylaxis in patients with newly diagnosed brain tumors. Report of the Quality Standards Subcommittee of the American Academy of Neurology. Neurol 2000; 54 (10) 1886-1893
• 9 Borgelt B, Gelber R, Kramer S , et al. The palliation of brain metastases: final results of the first two studies by the Radiation Therapy Oncology Group. Int J Radiat Oncol Biol Phys 1980; 6 (1) 1-9
• 10 Andrews DW, Scott CB, Sperduto PW , et al. Whole brain radiation therapy with or without stereotactic radiosurgery boost for patients with one to three brain metastases: phase III results of the RTOG 9508 randomised trial. Lancet 2004; 363 (9422) 1665-1672
• 11 Jenkinson MD, Haylock B, Shenoy A, Husband D, Javadpour M. Management of cerebral metastasis: evidence-based approach for surgery, stereotactic radiosurgery and radiotherapy. Eur J Cancer 2011; 47 (5) 649-655
• 12 Noel G, Medioni J, Valery CA , et al. Three irradiation treatment options including radiosurgery for brain metastases from primary lung cancer. Lung Cancer 2003; 41 (3) 333-343
• 13 Gaspar LE, Mehta MP, Patchell RA , et al. The role of whole brain radiation therapy in the management of newly diagnosed brain metastases: a systematic review and evidence-based clinical practice guideline. J Neurooncol 2010; 96 (1) 17-32
• 14 Tsao MN, Rades D, Wirth A , et al. Radiotherapeutic and surgical management for newly diagnosed brain metastasis (es): an American Society for Radiation Oncology evidence-basedguideline. Pract Radiat Oncol 2012; 2: 210-225
• 15 Tsao MN, Lloyd N, Wong R, Chow E, Rakovitch E, Laperriere N. Whole brain radiotherapy for the treatment of multiple brain metastases. Cochrane Database Syst Rev 2006; (3) CD003869
• 16 Tsao MN, Lloyd NS, Wong RK ; Supportive Care Guidelines Group of Cancer Care Ontario's Program in Evidence-based Care. Clinical practice guideline on the optimal radiotherapeutic management of brain metastases. BMC Cancer 2005; 5: 34
• 17 Patchell RA, Tibbs PA, Walsh JW , et al. A randomized trial of surgery in the treatment of single metastases to the brain. N Engl J Med 1990; 322 (8) 494-500
• 18 Patchell RA, Tibbs PA, Regine WF , et al. Postoperative radiotherapy in the treatment of single metastases to the brain: a randomized trial. JAMA 1998; 280 (17) 1485-1489
• 19 Aoyama H, Shirato H, Tago M , et al. Stereotactic radiosurgery plus whole-brain radiation therapy vs stereotactic radiosurgery alone for treatment of brain metastases: a randomized controlled trial. JAMA 2006; 295 (21) 2483-2491
• 20 Muacevic A, Kreth FW, Horstmann GA , et al. Surgery and radiotherapy compared with gamma knife radiosurgery in the treatment of solitary cerebral metastases of small diameter. J Neurosurg 1999; 91 (1) 35-43
• 21 O'Neill BP, Iturria NJ, Link MJ, Pollock BE, Ballman KV, O'Fallon JR. A comparison of surgical resection and stereotactic radiosurgery in the treatment of solitary brain metastases. Int J Radiat Oncol Biol Phys 2003; 55 (5) 1169-1176
• 22 Shaw E, Scott C, Souhami L , et al. Single dose radiosurgical treatment of recurrent previously irradiated primary brain tumors and brain metastases: final report of RTOG protocol 90–05. Int J Radiat Oncol Biol Phys 2000; 47 (2) 291-298
• 23 Mehta MP, Tsao MN, Whelan TJ , et al. The American Society for Therapeutic Radiology and Oncology (ASTRO) evidence-based review of the role of radiosurgery for brain metastases. Int J Radiat Oncol Biol Phys 2005; 63 (1) 37-46
• 24 Lippitz B, Lindquist C, Paddick I, Peterson D, O'Neill K, Beaney R. Stereotactic radiosurgery in the treatment of brain metastases: the current evidence. Cancer Treat Rev 2014; 40 (1) 48-59
• 25 Sneed PK, Suh JH, Goetsch SJ , et al. A multi-institutional review of radiosurgery alone vs. radiosurgery with whole brain radiotherapy as the initial management of brain metastases. Int J Radiat Oncol Biol Phys 2002; 53 (3) 519-526
• 26 Shehata MK, Young B, Reid B , et al. Stereotatic radiosurgery of 468 brain metastases < or =2 cm: implications for SRS dose and whole brain radiation therapy. Int J Radiat Oncol Biol Phys 2004; 59 (1) 87-93
• 27 Rogers LR, Rock JP, Sills AK , et al. Results of a phase II trial of the GliaSite radiation therapy system for the treatment of newly diagnosed, resected single brain metastases. J Neurosurg 2006; 105 (3) 375-384
• 28 Aoyama H, Tago M, Kato N , et al. Neurocognitive function of patients with brain metastasis who received either whole brain radiotherapy plus stereotactic radiosurgery or radiosurgery alone. Int J Radiat Oncol Biol Phys 2007; 68 (5) 1388-1395