tumorsMalignant tumoursMalignant tumours2224-50572587-6813Rosoncowebtumors-290Research ArticleСтатьиТАРГЕТНАЯ ТЕРАПИЯ ИЛИ ОБЛУЧЕНИЕ ВСЕГО ГОЛОВНОГО МОЗГА ПРИ МНОЖЕСТВЕННЫХ (>3 ОЧАГОВ) МЕТАСТАЗАХ: С ЧЕГО НАЧИНАТЬ ЛЕЧЕНИЕ?НасхлеташвилиД. Р.NaskhletashviliD. R.

Насхлеташвили Давид Романович – кандидат медицинских наук, старший научный сотрудник отделения нейрохирургии

nas-david@yandex.ruГорбуноваВ. А.GorbunovaV. A.

Горбунова Вера Андреевна – заведующая отделением химиотерапии

veragorbounova@mail.ruБекяшевА. Х.BekyashevA. H.

Бекяшев Али Хасьянович – заведующий отделением нейрохирургии

abekyashev@gmail.comДемидовЛ. В.DemidovL. V.

Демидов Лев Вадимович – заведующий отделением биотерапии опухолей

demidov.lev@gmail.comХаркевичГ. Ю.KharkevichG. Yu.

Харкевич Галина Юрьевна  – ведущий научный сотрудник отделение биотерапии опухолей

gkharkevich@mail.ruБановС. М.BanovS. M.

Банов Сергей Михайлович 

smbanov@gmail.comСамойленкоИ. В.SamoylenkoI. V.I.samoylenko@ronc.ruБарышниковК. А.BaryshnikovK. А.

Барышников Кирилл Анатольевич – старший научный сотрудник отделение биотерапии опухолей

kirill.baryshnikov@gmail.comОрловаК. В.OrlovaK. V.

Орлова Кристина Вячеславовна – научный сотрудник отделение биотерапии опухолей

krisman03@gmail.comУтяшевИ. А.UtyashevI. А.

Утяшев Игорь Аглямович – научный сотрудник отделение биотерапии опухолей

dr.utyashev@gmail.comПетенкоН. В.PetenkoN. N.

Петенко Наталья Николаевна – врач-онколог отделение биотерапии опухолей

n.petenko@gmail.comМаркинаИ. Г.MarkinaI. G.

Маркина Ирина Геннадьевна – врач-онколог отделение биотерапии опухолей

irina160771@yandex.ruМосквинаЕ. А.MoskvinaE. A.

Москвина Екатерина Анатольевна – научный сотрудник отделение нейрохирургии

k.moskvina@mail.ruМедведевС. В.MedvedevS. V.

Медведев  Сергей Васильевич – старший научный сотрудник отдел радиационной терапии

oncologrgmu@yandex.ruРоссийского онкологического научного центра имени Н. Н. БлохинаRussian FederationНаучно-исследовательский институт нейрохирургии имени академика Н.Н.БурденкоRussian Federation20161811201604s16773Copyright © Насхлеташвили Д.Р., Горбунова В.А., Бекяшев А.Х., Демидов Л.В., Харкевич Г.Ю., Банов С.М., Самойленко И.В., Барышников К.А., Орлова К.В., Утяшев И.А., Петенко Н.В., Маркина И.Г., Москвина Е.А., Медведев С.В., 20162016Насхлеташвили Д.Р., Горбунова В.А., Бекяшев А.Х., Демидов Л.В., Харкевич Г.Ю., Банов С.М., Самойленко И.В., Барышников К.А., Орлова К.В., Утяшев И.А., Петенко Н.В., Маркина И.Г., Москвина Е.А., Медведев С.В.Naskhletashvili D.R., Gorbunova V.A., Bekyashev A.H., Demidov L.V., Kharkevich G.Y., Banov S.M., Samoylenko I.V., Baryshnikov K.А., Orlova K.V., Utyashev I.А., Petenko N.N., Markina I.G., Moskvina E.A., Medvedev S.V.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://www.malignanttumors.org/jour/article/view/290

Лучевая терапия (ЛТ) на весь головной мозг является общепринятым стандартом при множественных (более 3-х очагов) метастазах в головном мозге. Но эффективность ЛТ различна  в зависимости от нозологической формы опухолевого заболевания и биологических характеристик опухоли. Так, если при раке молочной железы эффективность (частота полных и частичных регрессий метастазов в головном мозге) ЛТ на весь головной мозг при церебральных метастазах достигает 60%, то при меланоме не превышает 10%. При проведении  ЛТ на весь головной мозг (без противоопухолевой лекарственной терапии) медиана выживаемости колеблется от 1,5–3,0 месяцев при меланоме до 4,0–6,5 месяцев при раке легкого и раке молочной железы. Большинство летальных исходов (до 70–80%) у пациентов с церебральными метастазами связано с системным прогрессированием опухолевого процесса. Следует также учитывать риск когнитивных нарушений при ЛТ на весь головной мозг, который увеличивается у пациентов с более длительной выживаемостью (1 год и более), с относительно хорошим прогнозом. Многие пациенты, получающие таргетную терапию, живут более одного года. В связи с этим остается открытым вопрос о последовательности использования противоопухолевой лекарственной терапии и ЛТ на весь головной мозг у групп больных с относительно хорошим прогнозом, получающих таргетную терапию. Эффективность  таргетной терапии при метастатическом поражении головного мозга по литературным данным, а также по результатам собственных исследований, достигает: 50–66% при HER2-позитивном раке молочной железы с медианой выживаемости больных до 17,5 месяцев, 30–44,5% при меланоме с мутацией V600EBRAF с медианой выживаемости больных до 8,0 месяцев, 76–87% при аденокарциноме легкого с мутациями EGFR с медианой выживаемости больных до 18–22 мес., 55–69% при аденокарциноме легкого с транслокацией ALK с медианой выживаемости от 15 мес. до 49,5 мес. На основании данных этих исследований можно предложить проведение таргетной терапии в качестве первой линии лечения как одну из возможных опций в лечении больных с множественным метастатическим поражением головного мозга. Необходимы дальнейшие исследования по изучению таргетной терапии у пациентов с церебральными метастазами.

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The authors declare that there are no conflicts of interest present.