clinvestКачественная клиническая практикаKachestvennaya Klinicheskaya Praktika = Good Clinical Practice2588-05192618-8473ООО «Издательство ОКИ10.37489/2588-0519-2025-3-127-136KDJWJZclinvest-811Research ArticleПАЛЛИАТИВНАЯ МЕДИЦИНАPALLIATIVE CAREПаллиативная помощь пациентам с первичными и метастатическими опухолями головного мозгаPalliative care for patients with primary and metastatic brain tumorsВведенскаяЕ. С.VvedenskayaE. S.

Введенская Елена Станиславовна — к. м. н., врач-онколог, заведующий отделением паллиативной специализированной медицинской помощи; член профильной комиссии по паллиативной помощи Минздрава России 

Нижний Новгород

Elena S. Vvedenskaya — Cand. Sci. (Med.), oncologist, head of the department of palliative specialized medical care; member of the specialized commission on palliative care of the Ministry of Health of the Russian Federation

Nizhny Novgorod

elenavveden@mail.ruМольковА. М.MolkovA. М.

Мольков Александр Михайлович — анестезиолог-реаниматолог высшей категории, заведующий отделением анестезиологии и реанимации, анестезиолог отделения паллиативной специализированной медицинской помощи; ассистент кафедры анестезиологии, реаниматологии и трансфузиологии

Нижний Новгород

Aleksandr  M.  Molkov  — anesthesiologist-resuscitator of the highest category, head of the department of anesthesiology and resuscitation, anesthesiologist of the department ofpalliative specialized medical care; assistant of the department of anesthesiology, resuscitation and transfusiology

Nizhny Novgorod

malevich.83@mail.ruГБУЗ НО «Городская больница №28 Московского района г. Нижнего Новгорода»РоссияNizhny Novgorod City Hospital No. 28Russian FederationГБУЗ НО «Городская больница №28 Московского района г. Нижнего Новгорода»; ФГБОУ ВО «Приволжский исследовательский медицинский университет»РоссияNizhny Novgorod City Hospital No. 28; Privolzhsky Research Medical UniversityRussian Federation20253009202503127136Copyright © Введенская Е.С., Мольков А.М., 20252025Введенская Е.С., Мольков А.М.Vvedenskaya E.S., Molkov A.М.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://www.clinvest.ru/jour/article/view/811

Пациенты со злокачественными опухолями головного мозга и метастазами в головной мозг (ЗОГМ) страдают от тяжёлых симптомов на протяжении всего течения заболевания, что требует особого внимания и организации помощи для поддержания качества их жизни. В статье проведён обзор литературы с акцентом на практических аспектах облегчения наиболее распространённых и инвалидизирующих симптомов. Обсуждаются четыре основных темы: симптоматическое лечение; потребности лиц, осуществляющих уход; паллиативная помощь (ПП) во время противоопухолевого лечения и оказание помощи в конце жизни. Приводятся новые данные о профилактике нейрокогнитивного дефицита путём совершенствования методов лучевой терапии, выбора противосудорожных препаратов у пациентов с судорожным синдромом. Описаны основные возможности терапии или их отсутствие по борьбе со слабостью, прогрессированием нейрокогнитивного дефицита, головной и другими видами боли. Отмечаются особенности применения опиоидных анальгетиков у пациентов данной группы. Разработка и внедрение программ перспективного планирования медицинских мероприятий может помочь обеспечить целенаправленную помощь в  соответствии с  потребностями пациентов и лиц, осуществляющих уход, что может сократить объём госпитализации и избежать ненужной агрессивной медицинской помощи на завершающем этапе жизни. Необходима интеграция ПП в систему оказания медицинской помощи пациентам со ЗОГМ. Предлагается создание специализированной службы ПП для данной группы пациентов и целенаправленное обучение специалистов. Необходима разработка практических рекомендаций по оказанию поддерживающей / паллиативной помощи больным с ЗОГМ, в том числе на завершающем этапе жизни.

Patients with malignant brain tumors and brain metastases suffer from severe symptoms throughout the course of their disease, which requires special attention and comprehensive care to maintain their quality of life. This article provides a literature review, with an emphasis on the practical aspects of controlling the most common and disabling symptoms. Four main topics are discussed: symptom control, caregiver`s needs, palliative care during active cancer treatment, and end of life care. New data on the prevention of neurocognitive deficits through improved radiotherapy techniques and the choice of anticonvulsants for patients with seizure syndrome are presented. The main therapeutic options for managing weakness, neurocognitive decline, headache, and other types of pain are described, along with the current limitations of these treatments. The strategy for using opioids in this patient group is also discussed. The development and implementation of advance care planning programs can help ensure that care is aligned with the needs of patients and caregivers, which may reduce the volume of inpatient care and avoid unnecessary aggressive treatment at the end of life. The integration of palliative care into the healthcare system for patients with brain tumors is a paramount. There is a need to establish specialized palliative care services for this patient group and to provide targeted training for specialists. It is necessary to develop practical supportive and palliative care guidelines for patients with brain tumors, including end of life care.

метастазы в головной мозгопухоль мозгаглиомапаллиативная помощьсудорожный синдромголовная больдексаметазонсимптоматическая терапия при опухолях мозгазаблаговременное планирование помощинейрокогнитивные нарушенияпомощь в конце жизнибриварацетаминтеграция паллиативной помощиbrain metastasesbrain tumorgliomapalliative careseizure disorderheadachedexamethasonesymptomatic therapy for brain tumorsadvance care planningneurocognitive impairmentend of life carebrivaracetampalliative care integrationReferencesCancer incidence in five continents. Vol. XII. WHO. Cancer today. 2022. https://gco.iarc.who.int/today/en/dataviz/tables?mode=cancer&group_populations=1&multiple_populations=1Cancer incidence in five continents. Vol. XII. WHO. Cancer today. 2022. https://gco.iarc.who.int/today/en/dataviz/tables?mode=cancer&group_populations=1&multiple_populations=1Злокачественные новообразования в России в 2023 году (заболеваемость и смертность) /под ред. А.Д. Каприна [и др.]. М.: МНИОИ им. П.А. Герцена. 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The authors declare that there are no conflicts of interest present.