I. Overview
Intracranial metastasis (also called brain metastasis A) refers to the transfer of tumor cells originating from other parts of the body into the skull, and its incidence accounts for 3.5%-10% of intracranial tumors. Some articles reported that the brain metastasis rate of small cell lung cancer, if the survival period is more than two years, reaches 80%. Even if brain metastases are present, the origin of the tumor cannot be determined after surgery. The peak age of onset is 20-50 years old, with more men than women. Most brain metastases have a chronic onset, but the course of the disease tends to progress rapidly. Most patients have symptoms of central nervous system dysfunction, including headache in about 50% of patients, as well as common nausea, vomiting, speech disorders, limb weakness, ataxia, and cranial nerve palsy. 25% of patients have optic papilledema. The site of disease is mainly in the blood-rich areas such as the middle cerebral artery supply area, accounting for more than half of the cases. Small cell lung cancer often occurs in cerebellar metastases. Intracranial metastases 70%-80% are multiple.
II. Clinical manifestations
Brain metastases are often metastasized to the skull via blood flow, subarachnoid space, lymphatic system or direct invasion. The site of tumor occurrence is related to the blood supply and tissue volume of the disease area, and it is usually found in the brain cross-plasm, while meningeal and cranial metastases can also be seen.
Brain metastases can show signs and symptoms at any time of the primary tumor. Generally, lung cancer, melanosis and gastric cancer metastasize to the skull at an early stage, while breast, sarcoma and other gastrointestinal tumors metastasize to the skull at a later stage. Brain metastases have a short course, and the disease is progressively aggravated after the onset of the disease, such as sudden aggravation of tumor hemorrhage and necrosis, or stroke like onset. In the early stage, it only shows increasing headache, vomiting, optic papilla edema, epilepsy, and depending on the location of the lesion, limited localization signs such as hemiparesis, hemianesthesia, aphasia, nystagmus, ataxia and other signs may appear.
Diagnostic tests
1. Medical history
In addition to the symptoms of headache, vomiting, blurred vision, hemiplegia or monoplegia, slurred speech, etc., attention should be paid to the history of malignant tumors of lung, breast, adrenal gland, uterus, gastrointestinal, thyroid and other organs and history of surgery.
2.Physical examination Check whether there is optic papilledema and brain focal signs, and pay attention to check the sites of primary tumors such as lung, breast, lymph nodes, abdominal and pelvic organs to further determine the source of metastases.
3.CT and MRI scan
CT scan shows single or multiple abnormal density shadows in the brain, with clear borders, and large lesions may have low-density necrotic areas or high-density hemorrhagic foci, surrounded by severe edema. MRI shows low signal on T1-weighting and high signal on T2-weighting. MRI is the best diagnostic tool to detect brain metastases.
4.Systemic ancillary examination
Find the primary focus as much as possible. Check the thyroid, liver, prostate, pelvic organs, stomach and lung by ultrasound, radionuclide scan, whole gastrointestinal barium meal, gastroscopy, chest X-ray, chest CT and other organs for tumor lesions.
IV. Treatment
1. Indications for surgical treatment
①Single metastases, the primary foci have been removed or the primary foci have not been found yet, and those who can tolerate surgery;
② Multiple lesions, the larger ones have caused obvious intracranial hypertension threatening the life of patients.
2. Contraindications
①Patients with advanced primary tumor and cachexia.
②Patients with multiple lesions with diffuse cerebral edema.
3.γ-knife or X-knife treatment is suitable for single or multiple metastases, and its efficacy is similar to that of surgical treatment. The efficacy is similar to that of surgery, but the efficacy is poor if the primary lesion cannot be removed or if there are more than 3 lesions.
4.Chemotherapy Select chemotherapy drugs according to the pathological nature of the primary foci.
Principles
The treatment of patients with brain metastases generally requires comprehensive consideration according to the patient’s age, general condition, neurological function, primary tumor site and treatment, the presence of multiple metastases outside the brain, and the number, size and location of brain metastases, in order to choose the appropriate treatment plan.
1.Surgical treatment
It is mainly suitable for those with single metastases, whose primary foci have been removed or temporarily not yet found, and who can tolerate surgery; multiple lesions or larger ones have caused obvious intracranial hypertension threatening life. For those who have advanced primary tumor with malignant quality and multiple lesions with diffuse cerebral edema, surgery is contraindicated.
2.Radiation therapy
Radiotherapy is the main treatment method for brain metastases. If single or multiple brain metastases cannot be removed surgically or incompletely, radiotherapy can be used after hormone or decompression surgery, i.e., or certain brain metastases that have not been completely controlled by the primary foci can be selectively applied. In addition, radiotherapy is also an important adjuvant treatment for brain metastases after surgical resection.
Chemotherapy can be selected according to the pathological nature of the primary foci, and the most effective method is direct intrathecal injection.
4.CLS biological cell therapy
CLS cell therapy can not only effectively restore and strengthen the immune anti-tumor effect, but also increase the radiosensitivity of cancer cells, completely eliminate the residual cancer cells in the body, and reduce the recurrence and metastasis of tumor. It can reduce the recurrence and metastasis of tumor and improve the cure rate.
5.Chinese medicine treatment
For cancer patients’ bodies are weak, they can cooperate with Chinese medicine in the treatment process to reduce the pain of western medical treatment and accelerate the recovery of patients’ bodies.
6.Gamma knife radiation therapy
As a modern radiation therapy equipment, body gamma knife through the use of high dose fractionation and short course of time dose splitting mode, to the tumor local very high dose, while the surrounding tissues are subjected to a small amount, in the destruction of small lesions at the same time, can well protect the neighboring tissues and organs. And simply put, it is to make multiple beams of gamma-rays focus on the focal point through the rotating cone focusing mode, and the target of the lesion is irradiated with continuous high dose during treatment, while the surrounding normal tissues are irradiated with instantaneous low dose. Clinical observation shows that whole-body gamma knife can reduce the irradiation dose to the surrounding normal tissues more than X – knife, more effectively increase the unit volume dose and unit time dose in the target area, and more suitable for the treatment mode of high-dose fractionation and short treatment course.
A large number of clinical cases can prove that multiple brain metastases should be preferred to head gamma knife treatment. Because the gamma knife is to gather the rays in a focal point single administration of high-dose irradiation can kill the tumor cells sensitive to radiation, the patient can see the obvious effect within 1 month to 2 months after treatment review.
7, Chinese medicine treatment: the application of the combination of anti-tumor group formula series is suitable for patients who have not undergone surgery or partial resection of surgery, recurrence after surgery, X-knife, γ-knife, radiotherapy after 3-6 months of medication can eliminate the symptoms, make the tumor calcify or shrink and prevent recurrence, and the clinical application has been effective for many years.
8. Treatment of brain tumor secondary to epilepsy.
About 30% of patients with various types of brain tumors have epilepsy. Although some patients have their tumors surgically removed, epileptic symptoms have already occurred, because the etiology of tumors and epilepsy has not been completely eliminated, and such epilepsy can only be temporarily relieved by general anti-epileptic drugs. Therefore, in the treatment, we must start from the etiology of tumor epilepsy, and use Chinese medicine to treat the root of the disease and eliminate the tumor growth factors, so that the epilepsy symptoms can be completely controlled. Anti-tumor group formula series of drugs: anti-tumor and anti-epilepsy have good effects.