Cristaudo Agostino, Malorgio Antonio, Medoro Serena, Stefanelli Antonio
Department of Radiotherapy, Azienda Ospedaliero-Universitaria di Ferrara, Ferrara, Italy.
Radiat Oncol J. 2021 Mar;39(1):78-81. doi: 10.3857/roj.2020.00724. Epub 2021 Mar 3.
Brain metastases are common in stage IV malignant melanoma, carrying a prognosis traditionally regarded as severe, with a median survival of few months. Recently introduced systemic therapies as targeted therapy or immunotherapy have significantly improved the prognosis of metastatic melanoma. The optimal association of radiotherapy to such novel treatments has to be clarified. We report on a 43-year-old woman with 10 brain metastases. Three of them were treated with stereotactic radiosurgery (SRS) with complete response even of the untreated lesions. As the patient was BRAF-mutated, she was started on dabrafenib/trametinib. After 8 months she developed new brain metastases, which again responded to a new treatment with SRS. As after 7 months additional lesions appeared, she was treated with whole brain radiotherapy and was started on nivolumab. Twenty months after the first diagnosis of brain metastases the patient is fit without significant clinical and radiological signs of toxicity.
脑转移在IV期恶性黑色素瘤中很常见，传统上其预后被认为很差，中位生存期仅几个月。最近引入的全身治疗，如靶向治疗或免疫治疗，显著改善了转移性黑色素瘤的预后。放疗与这些新治疗方法的最佳联合方案仍有待明确。我们报告了一名43岁患有10个脑转移瘤的女性。其中3个接受了立体定向放射外科治疗（SRS），即使未治疗的病灶也完全缓解。由于该患者存在BRAF突变，开始使用达拉非尼/曲美替尼治疗。8个月后，她出现了新的脑转移瘤，再次接受SRS治疗后缓解。7个月后又出现了额外的病灶，她接受了全脑放疗，并开始使用纳武单抗治疗。首次诊断脑转移瘤20个月后，患者身体状况良好，没有明显的临床和影像学毒性迹象。
