Clinical Medicine and Pharmacology Clinical Medicine and Pharmacology Клиническая медицина и фармакология 2409-3750 50680 10.12737/2409-3750-2022-8-1-26-32 Обзоры reviews Обзоры METASTATIC LESION OF THE BRAIN. DIAGNOSIS AND TREATMENT МЕТАСТАТИЧЕСКОЕ ПОРАЖЕНИЕ ГОЛОВНОГО МОЗГА. ДИАГНОСТИКА И ЛЕЧЕНИЕ Бобков М. С. Bobkov M. S. Тульский государственный университет Tula State University 24 05 2022 24 05 2022 8 1 26 32 24 05 2022 https://naukaru.ru/en/nauka/article/50680/view

В статье приведен обзор современной литературы, посвященной диагностике и лечению вторичного (метастатического) поражения вещества головного мозга. На протяжении последних лет в России наблюдается высокий показатель заболеваемости злокачественными новообразованиями, с четко прослеживаемой тенденцией к росту. В 2019 году этот показатель составил 376,3 на 100 тысяч населения против 369,6 на 100 тысяч населения в 2018 году и 293,7 на 100 тысяч населения в 2000 году. Однако благодаря со-временным методам диагностики и лечения срок жизни пациентов, страдающих злокачественными новообразованиями, значительно увеличивается, и, как следствие, возрастает шанс «дожить» до момента возникновения метастатического поражения вещества головного мозга. Сегодня это грозное осложнение опухолевого процесса встречается примерно у 8-10% онкологических пациентов, при этом у большинства из них они носят симптомный характер. При некоторых нозологических формах злокачественных новообразований (мелко-клеточный рак легкого, меланома) частота метастазирования в головной мозг может достигать 80% и более.

The article provides an overview of the current literature on the diagnosis and treatment of second-ary (metastatic) damage to the brain substance. Over the past years, Russia has seen a high incidence of malignant neoplasms, with a clearly observed upward trend. In 2019, this figure was 376.3 per 100,000 population compared to 369.6 per 100,000 population in 2018 and 293.7 per 100,000 population in 2000. However, thanks to modern methods of diagnosis and treatment, the life span of patients suffering from malignant neo-plasms is significantly increased, and, as a result, the chance of “surviving” before the onset of a metastatic lesion of the brain substance increases. Today, this formidable complication of the tumor process occurs in approximately 8-10% of cancer patients, while in most of them they are symptomatic. In some nosological forms of malig-nant neoplasms (small cell lung cancer, melanoma), the frequency of brain metastasis can reach 80% or more.

 метастазы в мозг лучевая терапия радиохирургия 3D-конформная лучевая терапия кибер-нож гамма-нож магнитно-резонансная томография химиотерапия дистанционная лучевая терапия : brain metastases radiation therapy radiosurgery 3D conformal radiation therapy cyberknife gamma knife magnetic resonance imaging chemotherapy external beam radiation therapy

Банов, С.М. Метастатическое поражение головного мозга: современные клиниче-ские рекомендации / С.М. Банов, А.В. Голанов, М.Б. Долгушин [и др.]. //Онкологический журнал: лучевая диагностика, лучевая терапия. - 2018. Т. 1, № 3. - С. 75-84. Banov, S.M. Metastaticheskoe porazhenie golovnogo mozga: sovremennye kliniche-skie rekomendacii / S.M. Banov, A.V. Golanov, M.B. Dolgushin [i dr.]. //Onkologicheskiy zhurnal: luchevaya diagnostika, luchevaya terapiya. - 2018. T. 1, № 3. - S. 75-84. Голанов, А.В. Лечение пациентов с метастатическим поражением головного мозга: Проект клинических рекомендаций /А.В. Голанов, А.Х. Бекяшев, М.Б. Долгушин [и др.]. // Современная онкология. - 2015. - Т. 17, №3. - C. 109-117. Golanov, A.V. Lechenie pacientov s metastaticheskim porazheniem golovnogo mozga: Proekt klinicheskih rekomendaciy /A.V. Golanov, A.H. Bekyashev, M.B. Dolgushin [i dr.]. // Sovremennaya onkologiya. - 2015. - T. 17, №3. - C. 109-117. Долгушин, М.Б. Метастазы в головном мозге / М.Б. Долгушин, В.Н. Корниенко, И.Н. Пронин. - Москва: ИП "Т.А.Алексеева", 2017. Dolgushin, M.B. Metastazy v golovnom mozge / M.B. Dolgushin, V.N. Kornienko, I.N. Pronin. - Moskva: IP "T.A.Alekseeva", 2017. Ильялов, С.Р. Стереотаксическая радиохирургия внутримозговых метастазов рака с применением установки гамма-нож: дисс... канд. мед. наук: 14.00.28. 2008. Il'yalov, S.R. Stereotaksicheskaya radiohirurgiya vnutrimozgovyh metastazov raka s primeneniem ustanovki gamma-nozh: diss... kand. med. nauk: 14.00.28. 2008. Лучевая диагностика и терапия заболеваний головы и шеи: руководство / Под ред. Т.Н. Трофимовой. - 2013.- 888 с. (Серия "Национальные руководства по лучевой диагно-стике и терапии"). Luchevaya diagnostika i terapiya zabolevaniy golovy i shei: rukovodstvo / Pod red. T.N. Trofimovoy. - 2013.- 888 s. (Seriya "Nacional'nye rukovodstva po luchevoy diagno-stike i terapii"). Насхлеташвили, Д.Р. Практические рекомендации по лекарственному лечению ме-тастатических опухолей головного мозга /Д.Р. Насхлеташвили, О.В. Абсалямова, В.А. Але-шин [и др.] // Злокачественные опухоли. - 2015 - № 4, спецвыпуск. - С. 80-98. DOI: 10.18027/2224-5057-2015-4s-80-98 Nashletashvili, D.R. Prakticheskie rekomendacii po lekarstvennomu lecheniyu me-tastaticheskih opuholey golovnogo mozga /D.R. Nashletashvili, O.V. Absalyamova, V.A. Ale-shin [i dr.] // Zlokachestvennye opuholi. - 2015 - № 4, specvypusk. - S. 80-98. DOI: 10.18027/2224-5057-2015-4s-80-98 Онкология: национальное руководство / под ред. В.И. Чиссова, М.И. Давыдова. - М.: ГЭОТАР-Медиа, 2008. - 1072 с. Onkologiya: nacional'noe rukovodstvo / pod red. V.I. Chissova, M.I. Davydova. - M.: GEOTAR-Media, 2008. - 1072 s. Ошарин, В.В. Комбинированное лечение больных глиальными опухолями голов-ного мозга с применением внутритканевой брахитерапии с высокой мощностью дозы: дисс… канд. мед. наук: 14.00.14 ; 14.00.28. 2008. Osharin, V.V. Kombinirovannoe lechenie bol'nyh glial'nymi opuholyami golov-nogo mozga s primeneniem vnutritkanevoy brahiterapii s vysokoy moschnost'yu dozy: diss… kand. med. nauk: 14.00.14 ; 14.00.28. 2008. Смирнова, А.В., Кузьмин А.В., Плахотина Н.А., Лукина О.В. Оценка динамиче-ских изменений крупных метастазов глубинных отделов головного мозга после стереотак-сической лучевой терапии в режиме гипофракционирования. Лучевая диагностика и тера-пия. 2017;(1):40-46. Smirnova, A.V., Kuz'min A.V., Plahotina N.A., Lukina O.V. Ocenka dinamiche-skih izmeneniy krupnyh metastazov glubinnyh otdelov golovnogo mozga posle stereotak-sicheskoy luchevoy terapii v rezhime gipofrakcionirovaniya. Luchevaya diagnostika i tera-piya. 2017;(1):40-46. Aghi, M.K. The role of surgery in the management of patients with diffuse low grade glioma: A systematic review and evidence-based clinical practice guideline / Aghi MK, Nahed BV, Sloan AE [et al.] //J Neurooncol. 2015 Dec;125(3):503-30. doi: 10.1007/s11060-015-1867-1. Epub 2015 Nov 3. Aghi, M.K. The role of surgery in the management of patients with diffuse low grade glioma: A systematic review and evidence-based clinical practice guideline / Aghi MK, Nahed BV, Sloan AE [et al.] //J Neurooncol. 2015 Dec;125(3):503-30. doi: 10.1007/s11060-015-1867-1. Epub 2015 Nov 3. Ahmad, O. Biology and treatment of metastasis of sarcoma to the brain / Ahmad O., Chan M., Savage P. [et al.]. Front Biosci (Elite Ed). 2016 Jan 1;8:233-44. doi: 10.2741/E764. Ahmad, O. Biology and treatment of metastasis of sarcoma to the brain / Ahmad O., Chan M., Savage P. [et al.]. Front Biosci (Elite Ed). 2016 Jan 1;8:233-44. doi: 10.2741/E764. Aizer, A.A. Prophylactic cranial irradiation in patients with extensive-stage small cell lung cancer / A.A. Aizer, R. Mak, B.M. Alexander // Neuro-oncology. - 2017. - Vol. 19, No 8. - P.1015- 1016. Aizer, A.A. Prophylactic cranial irradiation in patients with extensive-stage small cell lung cancer / A.A. Aizer, R. Mak, B.M. Alexander // Neuro-oncology. - 2017. - Vol. 19, No 8. - P.1015- 1016. Akhoundova, D. 18F-FET PET for Diagnosis of Pseudoprogression of Brain Metastases in Patients With Non-Small Cell Lung Cancer / Akhoundova D., Hiltbrunner S., Mader C. [et al.] // Clin Nucl Med. 2020 Feb;45(2):113-117. doi: 10.1097/RLU.0000000000002890. Akhoundova, D. 18F-FET PET for Diagnosis of Pseudoprogression of Brain Metastases in Patients With Non-Small Cell Lung Cancer / Akhoundova D., Hiltbrunner S., Mader C. [et al.] // Clin Nucl Med. 2020 Feb;45(2):113-117. doi: 10.1097/RLU.0000000000002890. Aoyama, H. Neurocognitive function of patients with brain metastasis who received ei-ther whole brain radiotherapy plus stereotactic radiosurgery or radiosurgery alone / Aoyama H., Ta-go M., Kato N. [et al.] //Int J Radiat Oncol Biol Phys. 2007 Aug 1;68(5):1388-95. doi: 10.1016/j.ijrobp.2007.03.048. Aoyama, H. Neurocognitive function of patients with brain metastasis who received ei-ther whole brain radiotherapy plus stereotactic radiosurgery or radiosurgery alone / Aoyama H., Ta-go M., Kato N. [et al.] //Int J Radiat Oncol Biol Phys. 2007 Aug 1;68(5):1388-95. doi: 10.1016/j.ijrobp.2007.03.048. Barnholtz-Sloan, J.S. Incidence proportions of brain metastases in patients diagnosed (1973 to 2001) in the Metropolitan Detroit Cancer Surveillance System / Barnholtz-Sloan J.S., Sloan A.E., Davis F.G. [et al.] //J Clin Oncol. 2004 Jul 15;22(14):2865-72. doi: 10.1200/JCO.2004.12.149. Barnholtz-Sloan, J.S. Incidence proportions of brain metastases in patients diagnosed (1973 to 2001) in the Metropolitan Detroit Cancer Surveillance System / Barnholtz-Sloan J.S., Sloan A.E., Davis F.G. [et al.] //J Clin Oncol. 2004 Jul 15;22(14):2865-72. doi: 10.1200/JCO.2004.12.149. Brown, P.D. Whole-Brain Radiotherapy for Brain Metastases: Evolution or Revolution? / Brown P.D., Ahluwalia M.S., Khan O.H. [et al.] //J Clin Oncol. 2018 Feb 10;36(5):483-491. doi: 10.1200/JCO.2017.75.9589. Epub 2017 Dec 22. PMID: 29272161; PMCID: PMC6075843. Brown, P.D. Whole-Brain Radiotherapy for Brain Metastases: Evolution or Revolution? / Brown P.D., Ahluwalia M.S., Khan O.H. [et al.] //J Clin Oncol. 2018 Feb 10;36(5):483-491. doi: 10.1200/JCO.2017.75.9589. Epub 2017 Dec 22. PMID: 29272161; PMCID: PMC6075843. Buatti, J.M. RTOG 90-05: the real conclusion / Buatti JM, Friedman WA, Meeks SL, Bova FJ. // Int J Radiat Oncol Biol Phys. 2000 May 1;47(2):269-71. doi: 10.1016/s0360-3016(99)00506-4. Buatti, J.M. RTOG 90-05: the real conclusion / Buatti JM, Friedman WA, Meeks SL, Bova FJ. // Int J Radiat Oncol Biol Phys. 2000 May 1;47(2):269-71. doi: 10.1016/s0360-3016(99)00506-4. Chang, E.L. Neurocognition in patients with brain metastases treated with radiosurgery or radiosurgery plus whole-brain irradiation: a randomised controlled trial / Chang E.L., Wefel J.S., Hess K.R. [et al.] //Lancet Oncol. 2009 Nov;10(11):1037-44. doi: 10.1016/S1470-2045(09)70263-3. Epub 2009 Oct 2. Chang, E.L. Neurocognition in patients with brain metastases treated with radiosurgery or radiosurgery plus whole-brain irradiation: a randomised controlled trial / Chang E.L., Wefel J.S., Hess K.R. [et al.] //Lancet Oncol. 2009 Nov;10(11):1037-44. doi: 10.1016/S1470-2045(09)70263-3. Epub 2009 Oct 2. Congress of Neurological Surgeons Systematic Review and Evidence-Based Guidelines on the Role of Surgery in the Management of Adults With Metastatic Brain Tumors / B.V. Nahed, C. Alvarez-Breckenridge, P.K. Brastianos [et al.] // Neurosurgery. - 2019. - Vol. 84, No3. - E152-E155. Congress of Neurological Surgeons Systematic Review and Evidence-Based Guidelines on the Role of Surgery in the Management of Adults With Metastatic Brain Tumors / B.V. Nahed, C. Alvarez-Breckenridge, P.K. Brastianos [et al.] // Neurosurgery. - 2019. - Vol. 84, No3. - E152-E155. Congress of Neurological Surgeons Systematic Review and Evidence-Based Guidelines on the Role of Whole Brain Radiation Therapy in Adults With Newly Diagnosed Metastatic Brain Tumors / L.E. Gaspar, R.S. Prabhu, A. Hdeib [et al.] // Neurosurgery. - 2019. - Vol. 84, No3. - E159-E162. Congress of Neurological Surgeons Systematic Review and Evidence-Based Guidelines on the Role of Whole Brain Radiation Therapy in Adults With Newly Diagnosed Metastatic Brain Tumors / L.E. Gaspar, R.S. Prabhu, A. Hdeib [et al.] // Neurosurgery. - 2019. - Vol. 84, No3. - E159-E162. Congress of Neurological Surgeons Systematic Review and Evidence-Based Guidelines on the Role of Steroids in the Treatment of Adults With Metastatic Brain Tumors / T.C. Ryken, J.S. Kuo, R.S. Prabhu [et al.] // Neurosurgery. - 2019. - Vol. 84, No3. - E189- E191. Congress of Neurological Surgeons Systematic Review and Evidence-Based Guidelines on the Role of Steroids in the Treatment of Adults With Metastatic Brain Tumors / T.C. Ryken, J.S. Kuo, R.S. Prabhu [et al.] // Neurosurgery. - 2019. - Vol. 84, No3. - E189- E191. Dexamethasone and supportive care with or without whole brain radiotherapy in treating patients with non-small cell lung cancer with brain metastases unsuitable for resection or stereotactic radiotherapy (QUARTZ): results from a phase 3, non-inferiority, randomised trial / P. Mulvenna, M. Nankivell, R. Barton [et al.] // The Lancet. - 2016. - Т.388, No10055. - C.2004-2014. Dexamethasone and supportive care with or without whole brain radiotherapy in treating patients with non-small cell lung cancer with brain metastases unsuitable for resection or stereotactic radiotherapy (QUARTZ): results from a phase 3, non-inferiority, randomised trial / P. Mulvenna, M. Nankivell, R. Barton [et al.] // The Lancet. - 2016. - T.388, No10055. - C.2004-2014. Diagnosis and treatment of brain metastases from solid tumors: guidelines from the Eu-ropean Association of Neuro-Oncology (EANO) / R. Soffietti, U. Abacioglu, B. Baumert [et al.] // Neurooncology. - 2017. - Vol. 19, No2. - P.162-174. Diagnosis and treatment of brain metastases from solid tumors: guidelines from the Eu-ropean Association of Neuro-Oncology (EANO) / R. Soffietti, U. Abacioglu, B. Baumert [et al.] // Neurooncology. - 2017. - Vol. 19, No2. - P.162-174. Friendlander, A.H. Karnofsky performance status scale / Friendlander A.H., Ettinger R.L. // Spec Care Dentist. 2009 Jul-Aug;29(4):147-8. doi: 10.1111/j.1754-4505.2009.00088.x. Friendlander, A.H. Karnofsky performance status scale / Friendlander A.H., Ettinger R.L. // Spec Care Dentist. 2009 Jul-Aug;29(4):147-8. doi: 10.1111/j.1754-4505.2009.00088.x. Gavrilovic I.T. Brain metastases: epidemiology and pathophysiology / Gavrilovic I.T., Posner J.B. //J Neurooncol. 2005 Oct;75(1):5-14. doi: 10.1007/s11060-004-8093-6. Gavrilovic I.T. Brain metastases: epidemiology and pathophysiology / Gavrilovic I.T., Posner J.B. //J Neurooncol. 2005 Oct;75(1):5-14. doi: 10.1007/s11060-004-8093-6. Graber, J.J. Leptomeningeal Metastases / J.J. Graber, S. Kesari // Current treatment op-tions in oncology. - 2018. - Vol. 19, No1. - P.3. Graber, J.J. Leptomeningeal Metastases / J.J. Graber, S. Kesari // Current treatment op-tions in oncology. - 2018. - Vol. 19, No1. - P.3. Hatiboglu, M.A. Neurosurgical management of patients with brain metastasis / Hatiboglu M.A., Akdur K., Sawaya R. //Neurosurg Rev. 2020 Apr;43(2):483-495. doi: 10.1007/s10143-018-1013-6. Epub 2018 Jul 29. Hatiboglu, M.A. Neurosurgical management of patients with brain metastasis / Hatiboglu M.A., Akdur K., Sawaya R. //Neurosurg Rev. 2020 Apr;43(2):483-495. doi: 10.1007/s10143-018-1013-6. Epub 2018 Jul 29. Hotta M, Minamimoto R, Miwa K. 11C-methionine-PET for differentiating recurrent brain tumor from radiation necrosis: radiomics approach with random forest classifier. Sci Rep. 2019 Oct 30;9(1):15666. doi: 10.1038/s41598-019-52279-2. Hotta M, Minamimoto R, Miwa K. 11C-methionine-PET for differentiating recurrent brain tumor from radiation necrosis: radiomics approach with random forest classifier. Sci Rep. 2019 Oct 30;9(1):15666. doi: 10.1038/s41598-019-52279-2. International practice survey on the management of brain metastases: Third International Consensus Workshop on Palliative Radiotherapy and Symptom Control / M.N. Tsao, D. Rades, A. Wirth, S.S. Lo, B.L. Danielson, A. Vichare, C. Hahn, E.L. Chang // Clinical oncology (Royal Col-lege of Radiologists (Great Britain)). - 2012. - Vol. 24, No6. - e81-92. International practice survey on the management of brain metastases: Third International Consensus Workshop on Palliative Radiotherapy and Symptom Control / M.N. Tsao, D. Rades, A. Wirth, S.S. Lo, B.L. Danielson, A. Vichare, C. Hahn, E.L. Chang // Clinical oncology (Royal Col-lege of Radiologists (Great Britain)). - 2012. - Vol. 24, No6. - e81-92. Krishnan, P. CT-based Techniques for Brain Perfusion / Krishnan P., Murphy A., Aviv R.I. //Top Magn Reson Imaging. 2017 Jun;26(3):113-119. doi: 10.1097/RMR.0000000000000129. Krishnan, P. CT-based Techniques for Brain Perfusion / Krishnan P., Murphy A., Aviv R.I. //Top Magn Reson Imaging. 2017 Jun;26(3):113-119. doi: 10.1097/RMR.0000000000000129. Mindermann, T. Gamma Knife, CyberKnife or micro-multileaf collimator LINAC for in-tracranial radiosurgery? Acta Neurochir (Wien). 2015 Apr;157(4):557-8. doi: 10.1007/s00701-014-2275-6. Epub 2014 Nov 21. Erratum in: Acta Neurochir (Wien). 2015 Apr;157(4):567. PMID: 25413164. Mindermann, T. Gamma Knife, CyberKnife or micro-multileaf collimator LINAC for in-tracranial radiosurgery? Acta Neurochir (Wien). 2015 Apr;157(4):557-8. doi: 10.1007/s00701-014-2275-6. Epub 2014 Nov 21. Erratum in: Acta Neurochir (Wien). 2015 Apr;157(4):567. PMID: 25413164. Modha, A. Surgery of brain metastasis - Is there still a place for it? / Modha A., Shepard S., Gutin Ph //J Neuro-Oncology 75: 21-29; 2005. Modha, A. Surgery of brain metastasis - Is there still a place for it? / Modha A., Shepard S., Gutin Ph //J Neuro-Oncology 75: 21-29; 2005. Mut M. Surgical treatment of brain metastasis: a review. Clin Neurol Neurosurg. 2012 Jan;114(1):1-8. doi: 10.1016/j.clineuro.2011.10.013. Epub 2011 Nov 1. Mut M. Surgical treatment of brain metastasis: a review. Clin Neurol Neurosurg. 2012 Jan;114(1):1-8. doi: 10.1016/j.clineuro.2011.10.013. Epub 2011 Nov 1. Nabors, L.B. Central Nervous System Cancers, Version 3.2020, NCCN Clinical Practice Guidelines in Oncology / Nabors L.B., Portnow J., Ahluwalia M. [et al.] // J Natl Compr Canc Netw. 2020 Nov 2;18(11):1537-1570. doi: 10.6004/jnccn.2020.0052. Nabors, L.B. Central Nervous System Cancers, Version 3.2020, NCCN Clinical Practice Guidelines in Oncology / Nabors L.B., Portnow J., Ahluwalia M. [et al.] // J Natl Compr Canc Netw. 2020 Nov 2;18(11):1537-1570. doi: 10.6004/jnccn.2020.0052. Niranjan, A. Guidelines for Multiple Brain Metastases Radiosurgery / Niranjan A., Mon-aco E., Flickinger J., Lunsford L.D. // Prog Neurol Surg. 2019;34:100-109. doi: 10.1159/000493055. Epub 2019 May 16. Niranjan, A. Guidelines for Multiple Brain Metastases Radiosurgery / Niranjan A., Mon-aco E., Flickinger J., Lunsford L.D. // Prog Neurol Surg. 2019;34:100-109. doi: 10.1159/000493055. Epub 2019 May 16. Noh, T. Brain metastasis: clinical manifestations, symptom management, and palliative care / T. Noh, T. Walbert // Handb Clin Neurol. 2018;149:75-88. doi: 10.1016/B978-0-12-811161-1.00006-2. Noh, T. Brain metastasis: clinical manifestations, symptom management, and palliative care / T. Noh, T. Walbert // Handb Clin Neurol. 2018;149:75-88. doi: 10.1016/B978-0-12-811161-1.00006-2. Wowra, B. CyberKnife radiosurgery for brain metastasesт / B. Wowra, A. Muacevic, J.C. Tonn //Prog Neurol Surg. 2012;25:201-9. doi: 10.1159/000331193. Epub 2012 Jan 6. PMID: 22236681. Wowra, B. CyberKnife radiosurgery for brain metastasest / B. Wowra, A. Muacevic, J.C. Tonn //Prog Neurol Surg. 2012;25:201-9. doi: 10.1159/000331193. Epub 2012 Jan 6. PMID: 22236681.