Hopp til innhold
NHI.no
Annonse

Hjernemetastaser: Behandling

Innhold i artikkelen

Målet med behandlingen er symptomlindring, forsinke utviklingen av disse dattersvulstene og forlenge overlevelsen. Behandling fører praktisk talt aldri til helbredelse. Behandlingsmulighetene er kirurgi, gammakniv ("strålekniv"), stereotaktisk strålebehandling, fullhjernebestråling (radioterapi), steroidbehandling, kjemoterapi (cellegift).

Annonse

Alle pasienter med symptomatiske hjernemetastaser anbefales steroidbehandlet. Pasienter med småcellet lungekreft anbefales kjemoterapi.

Hvis det er maksimalt to metastaser i hjernen, pasienten ellers er rimelig "frisk" og fungerer godt i det daglige, kan det være aktuelt å overveie operasjon for å fjerne metastasen(e). Det er imidlertid avhengig av at metastasen(e) har en beliggenhet som gjør kirurgi mulig.

Hos pasienter med dårlige prognose eller mer enn to metastaser anbefales helhjerne-radioterapi og/eller steroidbehandling.

Vil du vite mer

Dette dokumentet er basert på det profesjonelle dokumentet Hjernemetastaser . Referanselisten for dette dokumentet vises nedenfor

  1. Brennum J, Kosteljanetz M, Roed HMH. Hjernemetastaser. Ugeskr Læger 2002; 164: 3522-6. PubMed
  2. Tse V. Brain metastasis. Medscape, last updated Aug 01, 2018. emedicine.medscape.com
  3. Lu-Emerson C, Eichler AF.Brain metastases. Continuum (Minneap Minn). 2012 Apr;18(2):295-311. PMID:22810128 PubMed
  4. Schellinger PD, Meinck HM, Thron A. Diagnostic accuracy of MRI compared to CT in patients with brain metastases. J Neurooncol 1999; 44: 275-81. PubMed
  5. Meling TR, Helseth E, Unsgård G, Nakstad PH, Wester K. Hjernemetastaser hos voksne. Tidsskr Nor Lægeforen 2005; 125: 2179-82. PubMed
  6. Soon YY, Tham IWK, Lim KH, Koh WY, Lu JJ. Surgery or radiosurgery plus whole brain radiotherapy versus surgery or radiosurgery alone for brain metastases. Cochrane Database of Systematic Reviews 2014, Issue 3. Art. No.: CD009454. The Cochrane Library
  7. Patchell RA, Tibbs PA, Walsh JW, Dempsey RJ, Maruyama Y, Kryscio RJ et al. A randomized trial of surgery in the treatment of single metastases to the brain. N Engl J Med 1990; 322: 494-500. New England Journal of Medicine
  8. Patchell RA, Tibbs PA, Regine WF, Dempsey RJ, Mohiuddin M, Kryscio RJ et al. Postoperative radiotherapy in the treatment of single metastases to the brain. JAMA 1998; 280: 1485-9. PubMed
  9. Tsao MN, Lloyd N, Wong RK, Chow E, Rakovitch E, Laperriere N, Xu W, Sahgal A. Whole brain radiotherapy for the treatment of newly diagnosed multiple brain metastases. Cochrane Database Syst Rev. 2012 Apr 18;4:CD003869. Review.PMID:22513917 PubMed
  10. Baardsen R, Larsen JL, Wester K et al. Hjernemetastaser behandlet med stereotaktisk gammabestråling - seks års erfaring med bruk av «gammakniven» ved Haukeland Sykehus. Tidsskr Nor Lægeforen 1997; 117: 1591-5. PubMed
  11. O'Neill BP, Iturria NJ, Link MJ et al. A comparison of surgical resection and stereotactic radiosurgery in the treatment of solitary brain metastases. Int J Radiat Oncol Biol Phys 2003; 55: 1169-76. PubMed
  12. Gerosa M, Nicolato A, Foroni R et al. Gamma knife radiosurgery for brain metastases: a primary therapeutic option. J Neurosurg 2002; 97 (suppl 5): 515-24.
  13. Hasegawa T, Kondziolka D, Flickinger JC et al. Brain metastases treated with radiosurgery alone: an alternative to whole brain radiotherapy? Neurosurgery 2003; 52: 1318-26. PubMed
  14. Linskey ME, Andrews DW, Asher AL et al. The role of stereotactic radiosurgery in the management of patients with newly diagnosed brain metastases: a systematic review and evidence-based clinical practice guideline. J Neurooncol2010;96:45–68. PMID:19960227 PubMed
  15. 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: 291-8. PubMed
  16. Bhatnagar A, Heron DE, Kondziolka D et al. Analysis of repeat stereotactic radiosurgery for progressive primary and metastatic CNS tumors. Int J Radiat Oncol Biol Phys 2002; 53: 527-32. PubMed
  17. Mehta MP, Paleologos NA, Mikkelsen T, et al. The role of chemotherapy in the management of newly diagnosed brain metastases: a systematic review and evidence-based clinical practice guideline. J Neurooncol. 2010 Jan;96(1):71-83. Epub 2009 Dec 4. Review.PMID:19960229 PubMed
  18. Vecht CJ, Hovestadt A, Verbiest HB et al. Dose-effect relationship of dexamethasone on Karnofsky performance in metastatic brain tumors: a randomized study of doses 4, 8, and 16 mg per day. Neurology 1994; 44: 675-80. Neurology
  19. Lagerwaard FJ, Levendag PC, Nowak PJCM, Eijkenboom WMH, Hanssens PEJ, Schmitz PIM. Identification of prognostic factors in patients with brain matastases: a review of 1292 patients. Int J Rad Oncol Biol Phys 1999; 43: 795-803. PubMed
  20. Brown PD, Brown CA, Pollock BEet al. Stereotactic radiosurgery for patients with «radioresistant» brain metastases. Neurosurgery 2002; 51: 656-65. PubMed
  21. Agboola O, Benoit B, Cross P, Da Silva V, Esche B, Lesiuk H et al. Prognostic factors derived from recursive partioning analysis (RPA) of Radiation Therapy Oncology Group (RTOG) brain metastases trials applied to surgically resected and irradiated brain metastases cases. Int J Radiat Oncol Biol Phys 1998; 42: 155-9. PubMed
  22. Gaspar LE, Scott C, Murray K, Curran W. Validation of the RTOG recursive partitioning analysis (RPA) classification for brain metastases. Int J Radiat Oncol Biol Phys 2000; 47: 1001-6. PubMed
  23. Vecht CJ, Haaxma-Reiche H, Noordijk EM, Padberg GW, Voormolen JH, Hoekstra FH et al. Treatment of single brain metastasis: Radiosurgery alone or combined with neurosurgery? Ann Neurol 1993; 35: 583-90. PubMed
  24. Mintz AP, Kestle J, Rathbone MP, Gaspar L, Hugenholtz H, Fisher B et al. A randomized trial to assess the efficacy of surgery in addition to radiotherapy in patients with a single cerebral metastasis. Cancer 1996; 78: 1470-6. PubMed
  25. Mekhail T, Sombeck M, Sollaccio R. Adjuvant whole-brain radiotherapy versus observation after radiosurgery or surgical resection of one to three cerebral metastases: results of the EORTC 22952-26001 study. Curr Oncol Rep 2011; 13: 255-8. pmid:21584645 PubMed
  26. Shonka N, Venur VA, Ahluwalia MS. Targeted Treatment of Brain Metastases. Curr Neurol Neurosci Rep. 2017 Apr. 17 (4):37. PMID: 28326470. PubMed
Annonse
Annonse