Department of Cutaneous Oncology, H Lee Moffitt Cancer Center and Research Institute, University of South Florida College of Medicine, Tampa, Florida 33612, USA.
Melanoma Res. 2012 Jun;22(3):177-83. doi: 10.1097/CMR.0b013e328352dbef.
The development of brain metastases is a frequent occurrence in patients with disseminated melanoma and contributes to a disproportionate degree of morbidity and mortality. The prognosis is markedly reduced once a patient is diagnosed with central nervous system disease. Definitive therapeutic interventions with resection or stereotactic radiosurgery have improved outcomes and become standard approaches in the management of melanoma brain metastases. With the inclusion of whole-brain radiation in these interventions, there has been a reduction in local recurrences, but no improvement in the overall survival. Still, many patients are not candidates for surgery nor radiotherapy nor develop progressive central nervous system disease after definitive therapy. As new immune-based and targeted therapeutic agents are developed for the treatment of metastatic melanoma, understanding their activity in brain metastases is necessary for effective patient management. In this review, we discuss the biology of brain metastases in metastatic melanoma, current treatment approaches with surgery and radiotherapy, and future systemic therapeutic strategies.
脑转移是黑色素瘤患者常见的并发症，导致发病率和死亡率不成比例地增加。一旦患者被诊断为中枢神经系统疾病，预后就会明显恶化。通过手术或立体定向放射外科进行确定性治疗干预已改善了结果，并成为黑色素瘤脑转移瘤治疗的标准方法。随着这些干预措施中加入全脑放疗，局部复发率有所降低，但总体生存率没有提高。尽管如此，许多患者不适合手术或放疗，或者在确定性治疗后中枢神经系统疾病仍会进展。随着新的免疫治疗和靶向治疗药物被开发用于治疗转移性黑色素瘤，了解它们在脑转移瘤中的活性对于有效的患者管理是必要的。在这篇综述中，我们讨论了转移性黑色素瘤中脑转移的生物学、手术和放疗的当前治疗方法，以及未来的全身治疗策略。
