Boaziz C, Breau J L, Morere J F, Israël L
Service d'oncologie médicale, hôpital Avicenne, Bobigny, France.
Bull Cancer. 1991;78(4):347-53.
Cerebral metastases of malignant melanoma are correlated with a very poor prognosis. Surgery of an isolated metastase can lead to a long survival but the brain lesions are frequently numerous and associated with an extracerebral diffusion. Dacarbazine (DTIC) gives a mean response rate of 21% on visceral localisations but doesn't cross the blood brain barrier (BBB). Neither do the biological response modifiers like Interleukin 2 (Il2) that leads to 25% response rate in disseminated melanoma. Nitrosoureas like carmustine (BCNU) and semustine (CCNU) have been investigated in different non randomised studies and the clinical results didn't illustrate their theorical ability to cross the BBB. Radiotherapy is also used as a palliative therapy with 7 to 16 weeks survival. Fotemustine (muphoran), a new amino acid linked nitrosourea, can give a response rate up to 28.2% in patients with cerebral metastases and the increased survival of responding patients is significant. The availability of this new drug may suggest associations with surgery and radiotherapy in the future to improve the survival of such patients.
恶性黑色素瘤的脑转移与极差的预后相关。孤立转移灶的手术可带来较长生存期，但脑内病变往往较多且伴有脑外扩散。达卡巴嗪（DTIC）对内脏转移灶的平均缓解率为21%，但无法透过血脑屏障（BBB）。生物反应调节剂如白细胞介素2（IL2）对播散性黑色素瘤的缓解率为25%，同样也无法透过血脑屏障。亚硝基脲类药物如卡莫司汀（BCNU）和司莫司汀（CCNU）在不同的非随机研究中进行了调查，临床结果并未证实它们理论上透过血脑屏障的能力。放疗也用作姑息治疗，生存期为7至16周。福莫司汀（Muphoran），一种新型的氨基酸连接亚硝基脲，对脑转移患者的缓解率可达28.2%，且缓解患者生存期的延长具有显著性。这种新药的出现可能意味着未来可与手术和放疗联合使用，以提高此类患者的生存期。
