nmpЖурнал им. Н.В. Склифосовского «Неотложная медицинская помощь»Russian Sklifosovsky Journal "Emergency Medical Care"2223-90222541-8017“N.V. Sklifosovsky Research Institute for Emergency Medicine”10.23934/2223-9022-2022-11-3-464-475nmp-1449Research ArticleОБЗОР ЛИТЕРАТУРЫREVIEWSРоль стереотаксической радиохирургии в лечении крупных интракраниальных метастазовThe Role of Stereotactic Radiosurgery in the Treatment of Large Brain Metastaseshttps://orcid.org/0000-0001-8099-9544ЕвдокимоваО. Л.EvdokimovaO. L.

Евдокимова Ольга Ливерьевна заведующая

129090, Москва, Большая Сухаревская пл., д. 3

Olga L. Evdokimova Head, Center for Radiosurgery

129090, Moscow, Bolshaya Sukharevskaya Sq., 3

liveryevna@yandex.ruhttps://orcid.org/0000-0002-8415-5602ТокаревА. С.TokarevA. S.

Токарев Алексей Сергеевич кандидат медицинских наук, научный сотрудник отделения неотложной нейрохирургии

129090, Москва, Большая Сухаревская пл., д. 3

Alexey S. Tokarev Candidate of Medical Sciences, Researcher, Department for Emergency Neurosurgery

129090, Moscow, Bolshaya Sukharevskaya Sq., 3

tokarev@neurosklif.ruhttps://orcid.org/0000-0002-4534-8719РакВ. А.RakV. A.

Рак Вячеслав Августович кандидат медицинских наук, врач-нейрохирург

129090, Москва, Большая Сухаревская пл., д. 3

Vyacheslav A. Rak Candidate of Medical Sciences, Neurosurgeon, Center for Radiosurgery

129090, Moscow, Bolshaya Sukharevskaya Sq., 3

rak@neurosklif.ruhttps://orcid.org/0000-0003-3515-8329ГриньА. А.GrinA. A.

Гринь Андрей Анатольевич член-корр. РАН, доктор медицинских наук, заведующий научным отделением неотложной нейрохирургии

129090, Москва, Большая Сухаревская пл., д. 3

Andrey A. Grin Corr. Member of RAS, Doctor of Medical Sciences, Head, Department for Emergency Neurosurgery

129090, Moscow, Bolshaya Sukharevskaya Sq., 3

grinaa@sklif.mos.ruhttps://orcid.org/0000-0003-2444-8136ПриродовА. В.PrirodovA. V.

Природов Александр Владиславович доктор медицинских наук, заведующий нейрохирургическим отделением

129090, Москва, Большая Сухаревская пл., д. 3

Alexander V. Prirodov Doctor of Medical Sciences, Head, Neurosurgical Department

129090, Moscow, Bolshaya Sukharevskaya Sq., 3

prirodovav@sklif.mos.ruЦентр радиохирургии ГБУЗ «Научно-исследовательский институт скорой помощи им. Н.В. Склифосовского ДЗМ»РоссияCenter for Radiosurgery N.V. Sklifosovsky Research Institute for Emergency MedicineRussian Federation202215102022113464475Copyright © Евдокимова О.Л., Токарев А.С., Рак В.А., Гринь А.А., Природов А.В., 20222022Евдокимова О.Л., Токарев А.С., Рак В.А., Гринь А.А., Природов А.В.Evdokimova O.L., Tokarev A.S., Rak V.A., Grin A.A., Prirodov A.V.This work is licensed under a Creative Commons Attribution 4.0 License.https://www.jnmp.ru/jour/article/view/1449

Стереотаксическая радиохирургия — один из наиболее современных методов лечения метастазов в головной мозг, однако ее ограниченная эффективность и безопасность при опухолях больших размеров представляет собой известную клиническую проблему. До сих пор ведутся споры о том, следует ли и в какой последовательности необходимо сочетать стереотаксическую радиохирургию церебральных метастазов с хирургической резекцией и что предпринять в случае невозможности удаления опухоли. Недостаточно изучена взаимосвязь специфичных параметров радиохирургии и радиобиологического эффекта: оптимальных характеристик курса облучения в зависимости от объема облучаемой опухоли, ее гистологического типа. В обзоре рассматриваются возможности применения стереотаксической радиохирургии для лечения крупных метастазов в головной мозг в составе комбинированной техники, а также в формате гипофракционированной стереотаксической радиохирургии.

Stereotactic radiosurgery is a modern treatment modality for patients with intracranial metastases. However, it has long been acknowledged that radiosurgery of large tumors results in limited efficacy and increased rate of complications. There have been still debates on the need of combination of radiosurgery and open surgery for intracranial metastases and the sequence of these modalities. The next question is about the proper treatment for metastases that could not be resected. There is a paucity of data describing the relationship between radiosurgical options and radiobiological effect, in particular how prescribed dose, type of fractionation, volume of irradiated tumor and morphology of cancer are related. The information presented in this review highlights opportunities of stereotactic radiosurgery for treatment of patients with large intracranial metastases in combination with open surgery as well as a stand-alone method when using hypofractionation regimen.

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