A systematic review of the published literature was conducted to analyze the management evolution of brain metastases from different cancers. Using the keywords “brain metastasis”, “brain metastases”, “CNS metastasis”, “CNS metastases”, “phase III” AND/OR “Randomized Controlled Trial” (RCT), relevant articles were searched for on the SCOPUS database. A total of 1986 articles were retrieved, published over a 45-year period (1977–2022). Relevant articles were defined as clinical studies describing the treatment or prevention of brain metastases from any cancer. Articles on imaging, quality of life, cognitive impairment after treatment, or primary brain tumors were excluded. After a secondary analysis, reviewing the abstracts and/or full texts, 724 articles were found to be relevant. Publications significantly increased in the last 10 years. A total of 252 articles (34.8%) were published in 12 core journals, receiving 50% of the citations. The number of publications in Frontiers in Oncology, BMC Cancer, and Radiotherapy and Oncology have increased considerably over the last few years. There were 111 randomized controlled trials, 128 review articles, and 63 meta-analyses. Most randomized trials reported on brain metastases management from unselected tumors (49), lung cancer (47), or breast cancer (11). In the last 5 years (2017 to 2022), management of brain metastasis has moved on from WBRT, the use of chemotherapy, and radio-sensitization to three directions. First, Radiosurgery or Radiotherapy (SRS/SRT), or hippocampal-sparing WBRT is employed to reduce radiation toxicity. Second, it has moved to the use of novel agents, such as tyrosine kinase inhibitors (TKI) and immune checkpoint inhibitors (ICI) and third, to the use of molecularly directed therapy such as TKIs, in asymptomatic low volume metastasis, obviating the need for WBRT.
为分析不同癌症脑转移治疗策略的演变，我们对已发表文献进行了系统性综述。在SCOPUS数据库中，以"脑转移"、"中枢神经系统转移"、"III期临床试验"和/或"随机对照试验"为关键词进行检索，共获得1986篇发表于45年间（1977-2022年）的相关文献。纳入标准为描述任何癌症脑转移治疗或预防的临床研究，排除涉及影像学、生活质量、治疗后认知障碍或原发性脑肿瘤的文献。经二次分析及摘要/全文筛选，最终确定724篇相关文献。近十年相关出版物显著增加，其中252篇（34.8%）发表于12种核心期刊，这些文献获得了总引用量的50%。近年来，《肿瘤学前沿》《BMC癌症》及《放射治疗与肿瘤学》期刊的发文量显著增长。文献类型包括111项随机对照试验、128篇综述及63项荟萃分析。多数随机试验涉及非选择性肿瘤（49项）、肺癌（47项）或乳腺癌（11项）的脑转移治疗。近五年（2017-2022年）脑转移治疗策略已从全脑放疗、化疗及放射增敏转向三个新方向：一是采用立体定向放射外科/放疗或海马回避全脑放疗以降低放射毒性；二是应用新型药物如酪氨酸激酶抑制剂和免疫检查点抑制剂；三是对无症状小体积转移灶采用分子靶向治疗（如酪氨酸激酶抑制剂），从而避免全脑放疗的应用。
Evolution of the Management of Brain Metastases: A Bibliometric Analysis
肿瘤(癌症)患者之家