Ahmed Kamran A, Freilich Jessica M, Sloot Sarah, Figura Nicholas, Gibney Geoffrey T, Weber Jeffrey S, Sarangkasiri Siriporn, Chinnaiyan Prakash, Forsyth Peter A, Etame Arnold B, Rao Nikhil G
Department of Radiation Oncology, H. Lee Moffitt Cancer Center and Research Institute, 12902 Magnolia Dr., Tampa, FL, 33612, USA,
J Neurooncol. 2015 Mar;122(1):121-6. doi: 10.1007/s11060-014-1685-x. Epub 2014 Dec 18.
While selective BRAF inhibitors have demonstrated improved outcomes in patients with metastatic BRAF V600E mutant melanoma, management of brain metastases prior to and during therapy presents challenges. Stereotactic radiosurgery (SRS) is an effective treatment for melanoma brain metastases, but there is limited safety and efficacy data on the use of SRS during BRAF therapy. An analysis was performed of patients with metastatic melanoma and brain metastases treated with SRS while on vemurafenib. MRI scans were reviewed post-SRS to evaluate local control (LC) as well as distant control. We identified 80 metastatic melanoma brain lesions treated in 24 patients. The median planning target volume was 0.28 cm(3) (range 0.05-4.19 cm(3)), and lesions were treated to a median dose of 24 Gy (range 15-24 Gy). The median follow up was 5.1 months (range 2-25.2 months). Eight (10 %) lesions showed progression at a median of 6.1 months (range 2-20.1 months) following SRS. Kaplan-Meier LC estimates at 6 and 12 months were 92 and 75 %, respectively. Fourteen (58 %) patients were noted to have distant brain failure at a median of 3.4 months (range 1.9-16.1 months) following treatment with SRS. Median overall (OS) from the date of SRS was 7.2 months (range 1.5-26.8 months) with a median of 11.9 months (range 1.5-28.5 months) since the date of brain metastases diagnosis. There was no evidence of increased toxicity with the combination of SRS and vemurafenib. SRS to brain metastases appears to be both safe and effective for patients treated concurrently with BRAF inhibitors.
虽然选择性BRAF抑制剂已证明可改善转移性BRAF V600E突变型黑色素瘤患者的预后，但在治疗前和治疗期间对脑转移瘤的管理仍存在挑战。立体定向放射外科手术（SRS）是治疗黑色素瘤脑转移瘤的有效方法，但关于在BRAF治疗期间使用SRS的安全性和有效性数据有限。对接受维莫非尼治疗期间接受SRS治疗的转移性黑色素瘤和脑转移瘤患者进行了分析。SRS后复查MRI扫描以评估局部控制（LC）以及远处控制。我们确定了24例患者中80个转移性黑色素瘤脑病灶。计划靶体积中位数为0.28 cm³（范围0.05 - 4.19 cm³），病灶接受的中位剂量为24 Gy（范围15 - 24 Gy）。中位随访时间为5.1个月（范围2 - 25.2个月）。8个（10%）病灶在SRS后中位6.1个月（范围2 - 20.1个月）出现进展。6个月和12个月时的Kaplan - Meier LC估计值分别为92%和75%。14例（58%）患者在接受SRS治疗后中位3.4个月（范围1.9 - 16.1个月）出现远处脑衰竭。自SRS之日起的中位总生存期（OS）为7.2个月（范围1.5 - 26.8个月），自脑转移瘤诊断之日起的中位生存期为11.9个月（范围1.5 - 28.5个月）。没有证据表明SRS与维莫非尼联合使用会增加毒性。对于同时接受BRAF抑制剂治疗的患者，SRS治疗脑转移瘤似乎既安全又有效。
