黑色素瘤脑转移的当前治疗方法和全球共识指南
Current Treatment Approaches and Global Consensus Guidelines for Brain Metastases in Melanoma.
作者信息
Tan Xiang-Lin, Le Amy, Lam Fred C, Scherrer Emilie, Kerr Robert G, Lau Anthony C, Han Jiali, Jiang Ruixuan, Diede Scott J, Shui Irene M
机构信息
Merck & Co., Inc., Rahway, NJ, United States.
Richard M. Fairbanks School of Public Health, Indiana University, Indianapolis, IN, United States.
出版信息
Front Oncol. 2022 May 5;12:885472. doi: 10.3389/fonc.2022.885472. eCollection 2022.
BACKGROUND
Up to 60% of melanoma patients develop melanoma brain metastases (MBM), which traditionally have a poor diagnosis. Current treatment strategies include immunotherapies (IO), targeted therapies (TT), and stereotactic radiosurgery (SRS), but there is considerable heterogeneity across worldwide consensus guidelines.
OBJECTIVE
To summarize current treatments and compare worldwide guidelines for the treatment of MBM.
METHODS
Review of global consensus treatment guidelines for MBM patients.
RESULTS
Substantial evidence supported that concurrent IO or TT plus SRS improves progression-free survival (PFS) and overall survival (OS). Guidelines are inconsistent with regards to recommendations for surgical resection of MBM, since surgical resection of symptomatic lesions alleviates neurological symptoms but does not improve OS. Whole-brain radiation therapy is not recommended by all guidelines due to negative effects on neurocognition but can be offered in rare palliative scenarios.
CONCLUSION
Worldwide consensus guidelines consistently recommend up-front combination IO or TT with or without SRS for the treatment of MBM.
背景
高达60%的黑色素瘤患者会发生黑色素瘤脑转移（MBM），传统上其诊断情况不佳。目前的治疗策略包括免疫疗法（IO）、靶向疗法（TT）和立体定向放射外科治疗（SRS），但全球共识指南存在相当大的异质性。
目的
总结当前的治疗方法，并比较全球范围内MBM的治疗指南。
方法
回顾针对MBM患者的全球共识治疗指南。
结果
大量证据支持，IO或TT联合SRS可改善无进展生存期（PFS）和总生存期（OS）。关于MBM手术切除的建议，指南并不一致，因为有症状病灶的手术切除可缓解神经症状，但不能改善OS。由于对神经认知有负面影响，并非所有指南都推荐全脑放射治疗，但在罕见的姑息治疗情况下可以采用。
结论
全球共识指南一致推荐，对于MBM的治疗，应首选IO或TT联合或不联合SRS的联合治疗方案。
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