Brain metastases (BMs) are the most prevalent type of cerebral tumor, significantly affecting survival. In adults, lung cancer, breast cancer, and melanoma are the primary cancers associated with BMs. Symptoms often result from brain compression, and patients may present to the emergency department (ED) with life-threatening conditions. The goal of treatment of BMs is to maximize survival and quality of life by choosing the least toxic therapy. Surgical resection followed by cavity radiation or definitive stereotactic radiosurgery remains the standard approach, depending on the patient’s condition. Conversely, whole brain radiation therapy is becoming more limited to cases with multiple inoperable BMs and is less frequently used for postoperative control. BMs often signal advanced systemic disease, and patients usually present to the ED with poorly controlled symptoms, justifying hospitalization. Over half of patients with BMs in the ED are admitted, making effective ED-based management a challenge. This article reviews the epidemiology, clinical manifestations, and current treatment options of patients with BMs. Additionally, it provides an overview of ED management and highlights the challenges faced in this setting. An improved understanding of the reasons for potentially avoidable hospitalizations in cancer patients with BMs is needed and could help emergency physicians distinguish patients who can be safely discharged from those who require observation or hospitalization.
脑转移瘤是最常见的颅内肿瘤类型，显著影响患者生存。在成人中，肺癌、乳腺癌和黑色素瘤是导致脑转移的主要原发癌。症状通常由脑组织受压引起，患者可能因危及生命的状况就诊于急诊科。脑转移瘤的治疗目标是通过选择毒性最小的疗法，最大限度地延长生存期并提高生活质量。根据患者具体情况，手术切除联合瘤腔放疗或确定性立体定向放射外科仍是标准治疗方案。相反，全脑放疗的应用范围正逐渐局限于多发不可手术的脑转移病例，术后控制中的应用频率有所降低。脑转移通常提示全身性疾病已进入晚期，患者常因症状控制不佳就诊于急诊科，这通常需要住院治疗。急诊科接诊的脑转移患者中超过半数需收治入院，这使得基于急诊科的有效管理面临挑战。本文综述了脑转移瘤患者的流行病学特征、临床表现及当前治疗方案，同时概述了急诊科的管理策略，并重点探讨了该场景下面临的挑战。我们需要更深入地理解脑转移癌症患者可能避免住院的原因，这将有助于急诊医师区分可安全出院的患者与需要观察或住院治疗的患者。
肿瘤(癌症)患者之家