研究比较了对脑病变治疗的认知结果

在患有1至3次脑转移的患者中，单独使用立体定向放射外科（SRS）与SRS与全脑放射治疗相结合，导致3个月的认知恶化较少，根据7月26日问题出现的研究贾马。

大约30％的耐心随着癌症发育脑转移，这些病变的发生率正在上升。大多数患者存在有限的颅内转移，通常定义为1至3个病变。立体定向放射牢是一种有效和常用的治疗对于脑转移，但颅内肿瘤进展仅在SRS中频繁，主要是因为新转移性病变的发展。全脑放射治疗（WBRT）在SRS后大脑中的肿瘤控制显着改善了肿瘤控制，但由于其与认知下降的关系，其在脑转移患者的作用仍然存在争议。

Paul D. Brown, M.D., of Mayo Clinic, Rochester, Minn., and colleagues conducted a study in which 213 patients with 1 to 3 brain metastases were randomly assigned to receive SRS alone (n = 111) or SRS plus WBRT (n = 102). The study was conducted at 34 institutions in North America; average patient age was 61 years. The primary outcome measured for the study was认知恶化在学习条目和3个月内完成评估的患者中。其他衡量结果包括生命质量，功能独立性，长期认知状态和整体生存。

研究人员发现，单独的SRS后3个月（40/63患者[64％]）比与WBRT合并（44/48名患者[92％]。生活质量在3个月内较高3个月单独，包括整体生活质量。治疗组之间的3个月内功能独立性没有显着差异。单独的SRS中位数总生存率为10.4个月，SRS加WBRT 7.4个月。对于长期幸存者，在3个月和12个月内单独患SRS后，认知劣化较少。

“在整体存活中没有差异，这些研究结果表明，对于1至3例脑转移的患者，即使放射外科术，SRS也可能是一个优选的策略，”作者写道。

"The debate between WBRT and SRS has been resolved for the specific type of patient (with 1-3 metastases) who enrolled in the current study, and there is little role for WBRT for these patients," write Carey K. Anders, M.D., of the University of North Carolina at Chapel Hill, and colleagues in an accompanying editorial.

“然而，两种治疗模式都在临床实践中具有有效的位置，因为许多患者均不精确地符合学习条目的特征。因此，基于来自目前研究的鲁棒发现，直到否则，WBRT可能仍然具有重要作用治疗of patients who are not in this specific disease category (i.e., 1-3 brain metastases). However, the study results cannot be extrapolated to infer that SRS is the standard for patients with 4 or more metastases or that WBRT no longer has a role in the treatment of脑转移。“

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