Behandlung von zerebralen Metastasen beim Mammakarzinom

Zusammenfassung

Die Behandlung von Mammakarzinompatientinnen mit Hirnmetastasen stellt eine interdisziplinäre Herausforderung dar. Sie erfordert eine differenzierte Indikationsstellung unter Berücksichtigung der therapeutischen Optionen. In Abhängigkeit der individuellen prognostischen Faktoren sollten strahlentherapeutische, operative und onkologische Modalitäten zum Einsatz kommen. Bei multiplen Hirnmetastasen ist die Ganzhirnbestrahlung und bei singulären oder solitären Hirnmetastasen die operative Metastasenentfernung mit nachfolgender Ganzhirnbestrahlung als etablierter Standard zu sehen.

Abstract

Treatment of patients with brain metastases is based on an interdisciplinary approach. It is essential to perform a differenziated indication for procedures with consideration of all therapeutical options like modalities of radiotherapy, surgery and oncology. In the case of multiple brain metastases the whole brain radiotherapy is the standard of treatment, while in case of a single or solitary brain metastasis surgical procedures followed by radiotherapy should be preferred.

Schlüsselwörter

Mammakarzinom - zerebrale Metastasen

Key words

Breast cancer - brain metastases

Literatur

• 1 Hall W A, Djalilian H R, Nussbaum E S, Cho K H. Long-term survival with metastatic cancer to the brain.  Med Oncol. 2000;  17 279-286
• 2 Hartman D L, Gaither J M, Kesler K A, Mylet D M, Brown J W, Mathur P N. Comparsion of insufflated talc under thoracoscopic guidance with standard tetracycline and bleomycin pleurodesis for control of malignant pleural effusions.  J Thorac Cardiovasc Surg. 1993;  105 743-747
• 3 Fentiman I S, Rubens R D, Hayward J L. A comparison of intracavitary talc and tetracycline for the control of pleural effusions secondary to breast cancer.  Eur J Cancer Clin Oncol. 1986;  22 1079-1081
• 4 Johnson K A, Kramer B S, Crane J M. Management of central nerrons system metastases in breast cancer. In: Bland K, Copeland EM III (eds). The Breast 1998; 1389-1402
• 5 Lagerward F J, Levendag P C, Nowak P J, Eijkenboom W M, Hansses P E, Schmitz P I. Identification of prognostic factors in patients with brain metastases: a review.  Int J Radiat Oncol Biol Phys. 1999;  43 795-803
• 6 Patchell R A, Cirrincione C, Thaler H AT. et al . Single Brain Metastasis: Surgery plus Radiation or Radiation Alone.  Neurology. 1986;  36 447-453
• 7 Nguyen L N, Maor M H, Oswald M J. Brain Metastases as the Only Manifestation of an Undetected Primary Tumor.  Cancer. 1998;  83 2181-2184
• 8 Mandell L, Hilaris B, Sullivan M. et al . The Treatment of Single Brain Metasasis From Non-Oat Cell Lung Carcinoma.  Cancer. 1986;  58 641-649
• 9 Noordijk E M, Vecht C J, Haaxma-Riche H. et al . The Choice of Treatment of Single Brain Metastasis Should Be Based on Extracranial Tumor Activity and Age.  Int J Radiation Oncology Biol Phys. 1994;  29 711-717
• 10 Mintz A H, Kestle J, Rathbone M P. A randomized trial to assess the efficacy of surgery in addition to radiotherapy in patients with single cerebral metastasis.  Cancer. 1996;  78 1470-1476
• 11 Patchell R A, Tibbs P A, Walsh J W. et al . A Randomized Trial of Surgery in the Treatment of Single Metastases to the Brain.  N Engl J Med. 1990;  322 494-500
• 12 Sause W T, Crowly J J, Morantz R. et al . Solitary Brain Metastasis: Results of an RTOG/SWOG Protocol Evaluation Surgery + RT versus RT Alone.  Am J Clin Oncol. 1990;  13 427-432
• 13 Vecht C J, Haaxma-Reiche H, Noordijk E M. et al . Treatment of Single Brain Metastasis: Radiotherapy Alone or Combined with Neurosurgery?.  Ann Neurol. 1993;  33 583-590
• 14 Smalley S R, Schray M F, Laws R L. et al . Adjuvant Radiation Therapy After Surgical Resection of Solitary Brain Metastasis: Association with Pattern of Failure and Survival.  Int J Radiation Oncology Biol Phys. 1987;  13 1611-1616
• 15 De Angelis L M, Mandell L R, Thaler H AT. et al . The Role of Postoperative Radiotherapy after Resection of Single Brain Metastases.  Neurosurgery. 1989;  24 798-805
• 16 Smalley S R, Laws E R, O'Fallon J R. et al . Resection for Solitary Brain Metastasis.  J Neurosurg. 1992;  77 531-540
• 17 Patchell R A, Tibbs P A, Regine W F. Postoperative Radiotherapy in the Treatment of Single Metastases to the Brain.  JAMA. 1998;  280 1485-1489
• 18 Schackert G, Steinmetz A, Meier U. et al . Surgical Management of Single and Multiple Brain Metastases: Results of a Retrospective Study.  Onkologie. 2001;  24 246-255
• 19 Bindal A K, Bindal R K, Hess K R. et al . Surgery versus radiosurgery in the treatment of brain metastasis.  J Neurosurg. 1996;  84 748-754
• 20 Auchter R M, Lamond J P, Alexander E. et al . A multiinstitutional outcome and prognostic factor analysis of radiosurgery for resectable single brain metastasis.  Int J Radiat Oncol Biol Phys. 1996;  35 27-35
• 21 Brandt R A, Cruz J, Scluajoliz J. et al .Neurosurgical treatment of brain metastasis: microsurgery or radiosurgery (abstract). 
• 22 Muacevic A, Kreth F W, Horstmann G A. et al . Surgery and Radiotherapy Compared with Gamma-Knife Radiosurgery in the Treatment of Solitary Cerebral Metastases of Small Diameter.  J Neurosurg. 1999;  91 35-43
• 23 Schöggl A, Kitz K, Reddy M. et al . Defining the Role of Stereotactic Radiosurgery Versus Microsurgery in the Treatment of Single Brain Metastases.  Acta Neurochir. 2000;  142 621-626
• 24 Chidel M A, Suh J H, Reddy C A. Application of Recursive Partitioning Analysis and Evaluation of the Use of Whole Brain radiation among Patients Treated with Stereotactic Radiosurgery for Newly Diagnosed Brain Metatases.  Int J Radiation Oncology Biol Phys. 2000;  47 993-999
• 25 Li B, Yu J, Suntharalingam M. Comparison of Three Treatment Options for Singl Brain Metastasis From Lung Cancer.  Int J Cancer (Radiat Oncol Invest). 2000;  90 37-45
• 26 Pirzkall A, Debus J, Lohr F. et al . Radiosurgery Alone or in Combination with Whole-Brain Radiotherapy for Brain Metastases.  JCO. 1998;  16 3563-3569
• 27 Sneed P K, Lamborn K R, Forstner J M. et al . Radiosurgery for Brain Metastases: Is Whole Brain Radiotherapy Necessary?.  Int J Radiation Oncology Biol Phys. 1999;  43 549-558
• 28 Fuller B G, Kaplan I D, Adler J. et al . Stereotactic Radiosurgery for Brain Metastases: The Importance of Adjuvant Whole Brain Irradiation.  Int J Radiation Oncology Biol Phys. 1991;  23 413-418
• 29 Kondziolka D, Patl A, Lunsford L D. et al . Stereotactic Radiosurgery Plus Whole Brain Radiotherapy Versus radiotherapy Alone for Patients with Multiple Brain Metastases.  Int J Radiation Oncology Biol Phys. 1999;  45 427-434
• 30 Prakash U B, Reiman H M. Comparsion of needle biopsy with cytologic analysis for the evaluation of pleural effusion: analysis of 414 cases.  Mayo Clin Proc. 1985;  60 158-164
• 31 Ruckdeschel J C, Moores D, Lee J Y, Einhorn L H, Mandelbaum I, Koeller J, Weiss G R, Losada M, Keller J H. Intrapleural therapy for malignant pleural effusion. A randomized comparison of bleomycin and tetracycline.  Chest. 1991;  100 1528-1535
• 32 Simonova G, Liscak R, Novotny J, Novotny J. Solitary brain metastases treated with the Leksell gamma knife: prognostic.  Radiother Oncol. 2000;  57 207-213
• 33 Zaloznik A J, Oswald S G, Langin M. Intrapleural tetracycline in malignant pleural effusions. A randomized study.  Cancer. 1983;  51 752-755
• 34 Gonzalez-Angulo A M, Cristofanilli M, Strom E A, Buzdar A U, Kau S W, Broglio K R, Smith T L, Hortobagyi G N. Central nervous system metastases in patients with high-risk breast carcinoma after multimodality treatment.  Cancer. 2004;  101 1760-1766