Abu-Gheida Ibrahim, Chao Samuel, Murphy Erin, Suh John, Stevens Glen H, Mohammadi Alireza M, McNamara Michael, Yu Jennifer S
Department of Radiation Oncology, Taussig Cancer Center Institute, Cleveland Clinic, Cleveland, OH, United States.
Department of Neurology, Neurological Institute, Cleveland Clinic, Cleveland, OH, United States.
Front Oncol. 2019 Mar 26;9:168. doi: 10.3389/fonc.2019.00168. eCollection 2019.
Melanoma brain metastasis with ependymal spread/metastases is uncommon. These cases are frequently classified together with leptomeningeal disease. However, the commonalities and differences in the underlying pathophysiology and clinical outcomes between these two types of spread are not clear. Very few reports on long term outcome and durable central nervous system (CNS) disease control have been reported in the literature. Here, we report a case of a 45 year-old Caucasian lady with BRAF-V600E mutant metastatic melanoma to the brain who had whole brain radiotherapy followed by two Gamma knife radiosurgery treatments for localized disease progression. She then developed extensive ependymal disease progression with no evidence of leptomeningeal spread. She was treated with a repeat course of whole brain radiotherapy and maintained on BRAF and MEK inhibitors with durable CNS disease control for more than a year. This study reviews the management of BRAF-V600E mutant melanoma with ependymal involvement. Management using radiation therapy with maintenance targeted therapy seems to be a reasonable approach to this challenging disease.
伴有室管膜播散/转移的黑色素瘤脑转移并不常见。这些病例常与柔脑膜疾病归为一类。然而，这两种播散类型在潜在病理生理学和临床结局方面的异同尚不清楚。文献中关于长期结局和持久的中枢神经系统（CNS）疾病控制的报道极少。在此，我们报告一例45岁的白种女性，其BRAF-V600E突变的转移性黑色素瘤脑转移，接受了全脑放疗，随后针对局部疾病进展进行了两次伽玛刀放射外科治疗。之后，她出现了广泛的室管膜疾病进展，无柔脑膜播散证据。她接受了重复疗程的全脑放疗，并持续使用BRAF和MEK抑制剂，CNS疾病得到持久控制超过一年。本研究回顾了伴有室管膜受累的BRAF-V600E突变黑色素瘤的治疗。采用放疗联合维持靶向治疗似乎是应对这种具有挑战性疾病的合理方法。
