Department of Radiation Oncology University Hospital Erlangen, Universitätsstraße 27, 91054, Erlangen, Germany,
Strahlenther Onkol. 2014 Nov;190(12):1169-72. doi: 10.1007/s00066-014-0698-x. Epub 2014 Jun 26.
Palliative radiotherapy is often required for patients with metastatic malignant melanoma in the case of bone or brain metastases. Since BRAF inhibitor therapy is highly efficient in V600-mutated melanomas, there is hesitation to stop it during radiotherapy. Consequently, radiotherapy under simultaneous vemurafenib treatment is frequently needed.
We report the case of a patient receiving palliative radiotherapy of spinal bone metastases before and during vemurafenib therapy. The skin reactions were quantitatively scored using computer-assisted digital image evaluation.
Radiotherapy without vemurafenib was tolerated very well, whereas radiotherapy under simultaneous vemurafenib treatment resulted in accentuated skin reactions. Furthermore, the patient developed dysphagia and had to be hospitalized for parenteral nutrition. In the quantitative analysis, there was a twofold increase in pigmentation and erythema of the irradiated skin area of the thoracic spine when vemurafenib was combined with radiotherapy compared with radiotherapy treatment alone. This is the first reported case of a patient showing no complications during radiotherapy without vemurafenib but remarkable skin and mucosal toxicity under concurrent vemurafenib therapy. Thus, a genetically conditioned individually elevated radiosensitivity can definitely be excluded. Compared with other reported cases, radiosensitization was not limited to the skin, but also affected the esophageal mucosa.
Vemurafenib is a strong radiosensitizer. Patients receiving radiotherapy under simultaneous vemurafenib treatment should be monitored very closely.
对于发生骨或脑转移的转移性恶性黑色素瘤患者，通常需要进行姑息性放疗。由于 BRAF 抑制剂治疗在 V600 突变型黑色素瘤中非常有效，因此在放疗期间会犹豫是否停止治疗。因此，经常需要在同时接受维莫非尼治疗的情况下进行放疗。
我们报告了一名患者在接受维莫非尼治疗期间和之前接受脊柱骨转移姑息性放疗的病例。使用计算机辅助数字图像评估对皮肤反应进行定量评分。
未联合维莫非尼的放疗耐受性非常好，而同时联合维莫非尼治疗的放疗则导致皮肤反应加剧。此外，患者出现吞咽困难，需要住院进行肠外营养。在定量分析中，与单独接受放疗相比，联合维莫非尼治疗时，放射性治疗的胸脊柱照射皮肤区域的色素沉着和红斑增加了两倍。这是首例报告的患者在没有维莫非尼的放疗期间没有出现并发症，但在同时接受维莫非尼治疗时出现明显的皮肤和黏膜毒性的病例。因此，肯定可以排除遗传条件导致的个体辐射敏感性增加。与其他报道的病例相比，放射增敏作用不仅限于皮肤，还影响食管黏膜。
维莫非尼是一种很强的放射增敏剂。接受同时接受维莫非尼治疗的放疗的患者应密切监测。
