Ersin HACIYAKUPOĞLU, Kadir OKTAY, Semih Kıvanç Olguner, Derviş Mansuri YILMAZ, Sebahattin HACIYAKUPOĞLU

Metastatik Beyin Tümörleri

Metastatik tümör; orjinini Santral Sinir Sistemi (SSS) dışındaki dokulardan alan primer sistemik kanserlerin sekonder olarak SSS ne yayılmasıdır. Erişkinde SSS ne en sık metastaz sırasıyla akciğer, meme, malign melanom, renal hücreli Ca, kolon ve tiroid kanserinden gelir. Akciğer kanseri %30-60 oranında beyine metastaz yapar. Çocukta beyin metastazı oldukça azdır. En sık lösemi, lenfoma, osteogenik sarkom, rhabdamyosarkom ve germ hücreli tümörler beyne metastaz yaparlar. Malign melanom, akciğer, meme ve kolon kanserleri %50 oranında multipl metastaz yaparken renal tümörler tek metastaz yapmaya meyillidir. Akciğer kanseri tanı koyduktan 6-9 ay sonra beyne metastaz yaparken, renal kanser 1 yıl, kolon kanseri 2 yıl, meme kanseri ve malign melanom 3 yıl sonra beyine metastaz yapabilir. %6 olguda primer tümöre ait hiçbir bulgu yokken beyine metastaz olmaktadır. Tedavide verilen ilk ilaç kortikosteroiddir, daha sonra ameliyat, Radyoterapi (RT), Kemoterapi (KT) ve Stereotaktik Radyosurgery (SRS) yapılabilir. Küçük hücreli akciğer kanseri, lenfoma, germ hücreli tümörler RT ve KT"ye hassastırlar. Non small akciğer kanserleri, renal, kolon, malign melanom radiorezistandır. Eğer hastada 3-4 aydan uzun yaşam süresi bekleniyorsa agresif tedavi uygulanır. RT"de verilen dozun total miktarı ve veriliş süresi ile ilgili akut ve kronik komplikasyonlar meydana gelir. Metastatik tümörlerin ameliyatlarında amaç nörolojik defisit olmadan tümörün total çıkartılması, intrakranial basıncın azaltılması ve eğer postoperatuar RT yapılacaksa dozun mümkün olduğu kadar düşük tutulmasıdır. Önceleri multipl metastazlar opere edilmemekte idi ancak ne kadar çok metastaz alınırsa RT ve KT den o kadar çok cevap alındığından günümüzde ameliyat önemlidir. Anahtar Kelimeler: Metastatik beyin tümörleri, Stereotaktik radyosurgery, Malign melanom, Akciğer kanserleri, Renal hücreli karsinom, Radyoterapi, Kemoterapi

Anahtar Kelimeler:

Metastatik beyin tümörleri, Stereotaktik radyosurgery, Malign melanom, Akciğer kanserleri, Renal hücreli karsinom, Radyoterapi, Kemoterapi

Metastatic Brain Tumors

Metastatic tumor is secondary spread to the central nervous system of primer systemic cancers originating from tissues other than the central nervous system. In adults; there are metastases respectively from lungs, breasts, malign melanoma, renal cell carcinoma, colon and thyroid cancers. 30-60% of lung cancers metastasis to the brain. In children there are quite a few cerebral metastases. Most commonly leukemia, lymphoma, osteogenic sarcoma, rhabdomyosarcoma and germ cell tumors metastasis to the brain. %50 of malign melanoma, lung, breast and colon cancers intend to make multipl metastases but renal cell cancers intend to make solitary metastasis.While lung cancers metastasis to brain in 6-9 months after the definitive diagnosis, renal cancers in 1 year, colon cancers in 2 years, breast cancers and malign melanoma in 3 years metastasis to brain. In 6% of cases there are cerebral metastasis while there isn"t a symptom of a primary tumor. For treatment corticosteroids, surgery, Radiotherapy(RT), Chemotherapy(CT) and Stereotactic Radiosurgery(SRS) can be implemented. Small cell lung cancers, lymphoma, germ cell tumors are sensitive to RT and CT. Non small cell lung cancers, renal, colon cancers and malign melanoma are radioresistant. The purposes in the surgery of the metastatic brain tumors are; total resection of tumors without neurologic deficits, decreasing the intracranial pressure and decreasing the dose of postoperative radiotherapy. Key Words: Metastatic brain tumors, Stereotactic radiosurgery, Malign melanoma, Lung cancers, Renal cell carcinoma, Radiotherapy, Chemotherapy

Keywords:

Metastatic brain tumors, Stereotactic radiosurgery, Malign melanoma, Lung cancers, Renal cell carcinoma, Radiotherapy, Chemotherapy,

PDF

___

Sawaya R, Bindal KR, Lang FF, Suhi D. Metastatic Brain Tumors. Eds: Kaya HA, Laws RE Brain Tumors. Saunders Edinburg. 2012:864-93.
Kondziolka D, Niranjan A, Lunsford DL, Clump AD, Flickinger CJ. Radiosurgery and Radiotherapy for Brain Tumors. eds; Kaye HA, Laws RE. Brain Tumors Elsevier Edinburg. 2012:296-305.
Woo YS, Mahajan A. Radiobiology of the Central Nervous System. eds; Bernstein M, Berger SM. Neuro Oncology Thime. 2008;143-9: Young B Patchell AR. Metastatic Tumors. eds; Rengachary SS, Wilkins HR. Princeples og Neurosurgery mosby Hong-Kong. 1994;27:2-27.
Hawe K, Cook JD, Rutka TJ. Gene Therapy for Human Brain Tumors. eds; Kaye HA, Laws RE. Brain Tumors Elsevier Edinburg. 2012;114-25.
Farhadi FH, Rutka TJ. Molecular Markere and Pathways in Brain Tumorigenesis. eds; Bernstein M, Berger SM . Neuro- oncology Thime.:2008;32-8.
Carlotti GC, Dirks BP, Rutka TJ Basic Brain Tumor Biology: Invasion, Agiogenesis, and proliferation eds; Batjer HH, Loftus MC. Textbook of Neurosurgery Surgery Philadelphia V. 2003;1215-28.
Perry A, Leonardo RJ, Roth AK, Gutmann HD. Brain Tumor Genetics. eds; Batjer HH, Loftus MC. Textbook of Neurosurgery Surgery Philadelphia I. 2003;1:3-9.
Abdullah N, Mathews PV. E. Mangnetic Ressonance Imaging of the Brain. eds; Batjer HH, Loftus MC. Textbook of Neurosurgery Surgery Philadelphia I. 2003;1:147-65.
Harsh RG. Neuro-Oncolgy. eds; Rengachary SS, Wilkins HR. Principles og Neurosurgery mosby Hong-Kong. 1994;25:2-25
Pang D, Craniopharyngiomas. eds; Rengachary SS, Wilkins HR. Princeples og Neurosurgery mosby Hong-Kong:35.2-35.26:1994
Weingart J, Brem H, Basic Principles of Cranial Surgery for Brain Tumors. eds; Winn Richard H. Neurological Surgery Saunders Philadelphia I. 1996;899-908.
Lang FF, Chang LE, Abi-Said D, Wildrick MD,Sawaya R. Metastatic Brain Tumors. Eds; Winn RH. Neurological Surgery Saunders Philadelphia I. 1996;1077-98.
Petritsch C, Vanderberg RS. Stem cells and progenitor cell lineages as targets for neoplastic transformation in the central neurous system. eds; Kaye HA, Laws RE. Brain Tumors Elsevier Edinburg. 2002;6-35: Gilles GG. Epidemiology of Brain Tumors. eds; Kaye
HA, Laws RE. Brain Tumors Elsevier Edinburg. 2012;59-82.
Walker GD. Immunology of Brain Tumors and Implications for Immunutherapy. eds; Kaye HA, Laws RE. Brain Tumors Elsevier Edinburg. 2012;125-137.
Raifen J, Thiele HR, Nemergut CE . Anesthesia and Intensive care Management of Patients with Brain Tumors. eds; Kaye HA, Laws RE. Brain Tumors Elsevier Edinburg. 2012;249-81.
Drummond JK, Ojemann GR. Surgical Principles in the Management of Brain Tumors. . eds; Kaye HA, Laws RE. Brain Tumors Elsevier Edinburg. 2012;282
Pouration N, Citarelli PC, Shaffrey EM, Schiff D.. Clinical Trials and Chemotherapy eds; Kaye HA, Laws RE. Brain Tumors Elsevier Edinburg. 2012;306
Keles EG, Berger SM. Functional Mapping. eds; Bernstein M, Berger JM. Neuro Oncology Thime. 2008;126-31.
Bauman SG, Larson AD. Fractionated Stereotactic Radiotherapy. eds; Bernstein M, Berger JM . Neuro Oncology Thime. 2008;150-7.
Glick PR, Lichtor T. Immunobiology and Immune Therapy. eds; Bernstein M, Berger JM. Neurooncolology Thime. 2008;213-23.
Engelhard HH. Stereotactic Craniotomy for tumor.eds: Batjer HH, Loftus MC. Textbook of Neurological Surgery Philadelphia III: 2003;2667-73.
Chang MS, Johnson RD. Biogic Therapy for Malignun Gliomu. eds; Kaye HA, Laws RE. Brain Tumors Elsevier Edinburg. 2012;102-13.
Coffey JR. Stereotactic Radiosurgery and Focused Beam Irradiation. Eds; Rengachary SS, Wilkins HR. Principles of Neurosurgery Mosby Hong Kong. 42.28:1994
Mc Donald JD, Gutin PH. Intersititıal Brachytherapy. eds: Batjer HH, Loftus MC. Textbook of Neurological Surgery. The American Association of Neurological Surgeons Philadelphia II. 1992;143-51.
Marlin AE, Gaskin SJ. Cerebellar Medulloblastoma. eds; Rengachary SS, Wilkins HR. Neurosurgical Operative Atlas The American Association of Neurological Surgeons İllionois l. 1991;189-96.
Gonzales M. Classification and Pathogenesis of Brain Tumors. eds; Kaye HA, Laws RE. Brain Tumors Elsevier Edinburg. 2012;36-58.
Chandra VR, King JAJ. Advaces Imaging of Brain Tumors. eds; Kaye HA, Laws RE. Brain Tumors Elsevier Edinburg. 2012;188-214.
Roth J, Costantini S, Rosenfeld US. Management of brain tumors in the pediatric patien . eds; Kaye HA, Laws RE. Brain Tumors Elsevier Edinburg. 2012;329
Maber OC, Friedman AJ, Raffel C. Posterior Fossa Tumor in Children. eds; Batjer HH, Loftus MC. Textbook of Neurosurgery Surgery Philadelphia. 2003;IV:985-97.
Brem H, Weingart DJ, Kunwar S. Intratumoral Cheomptherapy. eds; Bernstein M, Berger MS. Neuro-oncolology Thieme. 2008;183-91.
Kondziolka D, Gerszten CP. Stereotactic Radiosurgery. eds; Bernstein M, Berger JM . Neuro Oncology Thime. 2008;158-70.
CabebellKL, Ross DA. Stereotactic Microsurgucal Craniotomy fort he Treatment of Third Ventricular Colloid Cysts. Eds; Rengachary SS, Wilkins HR. Neurosurgical Operative Atlas. The American Association of Neurological Surgeons İllionois.1997:VI: 251-256
Yazışma Adresi / Address for Correspondence: Dr. Kadir Oktay Çukurova Üniversitesi Tıp Fakültesi Beyin ve Sinir Cerrahisi Anabilim Dalı Email: drkadiroktay@hotmail.com geliş tarihi/received :13.11.2013 kabul tarihi/accepted:16.12.2013