Samlowski Wolfram E, Jensen Randy L, Shrieve Dennis C
Section of Melanoma, Renal Cancer & Immunotherapy, Nevada Cancer Institute, One Breakthrough Way, 10441 W. Twain Ave., Las Vegas, NV 89135, USA.
Expert Rev Anticancer Ther. 2007 Dec;7(12):1699-705. doi: 10.1586/14737140.7.12.1699.
Brain metastases are a frequent complication of advanced melanoma. Neurosurgery (generally followed by radiotherapy) may be useful in managing solitary, superficial brain metastases in good performance status patients, as well as for diagnostic purposes. Since most patients are not felt to be resectable and concurrent extracranial metastases frequently are present, whole-brain radiotherapy (WBRT) has become the de facto treatment standard. WBRT has resulted in disappointing outcomes, resulting in a 3.6-4.1-month median survival. Recent studies have suggested that focal irradiation using linear accelerator-based stereotactic radiosurgery or gamma-knife technologies can result in excellent local control and prolonged survival in some patients. It is possible that more aggressive combined modality treatment strategies, such as addition of systemic therapy, may further improve outcome. Current data suggest that aggressive treatment of patients with up to five brain melanoma brain metastases is capable of producing prolonged survival in many patients, including some long-term complete responses.
脑转移是晚期黑色素瘤常见的并发症。神经外科手术（通常随后进行放疗）对于身体状况良好的患者处理孤立、表浅的脑转移灶可能有用，也可用于诊断目的。由于大多数患者被认为无法切除且常伴有颅外转移，全脑放疗（WBRT）已成为事实上的治疗标准。WBRT的治疗效果令人失望，中位生存期为3.6 - 4.1个月。最近的研究表明，使用基于直线加速器的立体定向放射外科或伽玛刀技术进行局部照射，在一些患者中可实现良好的局部控制并延长生存期。采用更积极的联合治疗策略，如加用全身治疗，可能会进一步改善治疗效果。目前的数据表明，积极治疗脑转移灶达5个以下的黑色素瘤患者，许多患者能够获得延长的生存期，包括一些长期完全缓解的患者。
