Sloan Andrew E, Nock Charles J, Einstein Douglas B
Brain Tumor & Neuro-Oncology Center and the Neurological Institute, University Hospital Case Medical Center, Cleveland, Ohio 44106, USA.
Cancer Control. 2009 Jul;16(3):248-55. doi: 10.1177/107327480901600307.
Brain metastasis is common in patients with malignant melanoma and represents a significant cause of morbidity and mortality. Nearly 37% of patients with malignant melanoma eventually develop brain metastasis, and autopsy reports show that 75% of those who died of this disease developed brain metastasis.
We review the level I and level II evidence that guides indications for treatment with surgery, stereotactic radiosurgery, chemotherapy, and immunotherapy for patients with melanoma brain metastasis.
Level I evidence supports the role of whole brain radiotherapy, microsurgery, and radiosurgery alone or in combination for the treatment of patients with melanoma brain metastasis. Chemotherapy has been ineffective. Ongoing studies continue to assess the effects of immunotherapy and agents in development.
Brain metastasis is a common and formidable challenge in patients with malignant melanoma. Although there have been no randomized controlled trials exclusively in patients with melanoma brain metastasis, care can be guided by the application of level I evidence for the treatment of brain metastasis in general and phase II studies focusing specifically on melanoma brain metastasis. Promising new agents and approaches are needed and will hopefully be identified in the near future.
脑转移在恶性黑色素瘤患者中很常见，是发病和死亡的重要原因。近37%的恶性黑色素瘤患者最终会发生脑转移，尸检报告显示，死于该病的患者中有75%发生了脑转移。
我们回顾了指导黑色素瘤脑转移患者手术、立体定向放射外科、化疗和免疫治疗指征的I级和II级证据。
I级证据支持全脑放疗、显微手术和放射外科单独或联合用于治疗黑色素瘤脑转移患者。化疗一直无效。正在进行的研究继续评估免疫治疗和正在研发的药物的效果。
脑转移是恶性黑色素瘤患者常见且严峻的挑战。尽管目前尚无专门针对黑色素瘤脑转移患者的随机对照试验，但可根据一般脑转移治疗的I级证据应用以及专门针对黑色素瘤脑转移的II期研究来指导治疗。需要有前景的新药物和新方法，有望在不久的将来得以确定。
