Melanoma Institute Australia and The University of Sydney, Sydney, New South Wales, Australia.
The University of Texas MD Anderson Cancer Center, Houston, Texas.
Pigment Cell Melanoma Res. 2019 Jul;32(4):553-563. doi: 10.1111/pcmr.12775. Epub 2019 Mar 3.
Brain radiotherapy is used in the management of melanoma brain metastases (MBM) and can result in radionecrosis. Anti-PD-1 is active in the brain and may increase the risk of radionecrosis when combined with radiotherapy. We studied the incidence, associated factors and management of radionecrosis in longer-term survivors with MBM treated with this combination.
Patients with MBM treated with radiotherapy and anti-PD-1 who survived >1 year were identified to determine radionecrosis incidence (Cohort A, n = 135). Cohort A plus additional radionecrosis cases were examined for factors associated with radionecrosis and management (Cohort B, n = 148).
From Cohort A, 17% developed radionecrosis, with a cumulative incidence at 2 years of 18%. Using Cohort B, multivariable analysis confirmed an association between radionecrosis and elevated lactate dehydrogenase (p = 0.0496) and prior treatment with ipilimumab (p = 0.0319). Radionecrosis was diagnosed based on MRI (100%), symptoms (69%) and pathology (56%). Treatment included corticosteroids, bevacizumab and neurosurgery.
Radionecrosis is a significant toxicity in longer-term melanoma survivors with MBM treated with anti-PD-1 and radiotherapy. Identification of those at risk of radionecrosis who may avoid radiotherapy is required.
脑部放射治疗用于黑色素瘤脑转移（MBM）的治疗，可能导致放射性坏死。抗 PD-1 在脑部具有活性，与放射治疗联合使用时可能会增加放射性坏死的风险。我们研究了接受这种联合治疗的 MBM 长期幸存者中放射性坏死的发生率、相关因素和治疗方法。
确定了接受放射治疗和抗 PD-1 治疗且存活时间超过 1 年的 MBM 患者，以确定放射性坏死的发生率（队列 A，n=135）。队列 A 加上其他放射性坏死病例，检查与放射性坏死相关的因素和治疗方法（队列 B，n=148）。
从队列 A 中，17%的患者发生放射性坏死，2 年的累积发生率为 18%。使用队列 B，多变量分析证实放射性坏死与乳酸脱氢酶升高（p=0.0496）和先前使用伊匹单抗治疗（p=0.0319）有关。放射性坏死的诊断依据 MRI（100%）、症状（69%）和病理（56%）。治疗包括皮质类固醇、贝伐单抗和神经外科手术。
在接受抗 PD-1 和放射治疗的 MBM 长期黑色素瘤幸存者中，放射性坏死是一种严重的毒性反应。需要确定那些有放射性坏死风险的患者，以避免放射治疗。
