Department of Neuro-Oncology, Erasmus MC Cancer Institute, Rotterdam, the Netherlands; Department of Medical Oncology, Erasmus MC Cancer Institute, Rotterdam, the Netherlands; Department of Radiology & Nuclear Medicine, Erasmus MC, Rotterdam, the Netherlands.
Department of Medical Oncology, Erasmus MC Cancer Institute, Rotterdam, the Netherlands; Department of Radiology & Nuclear Medicine, Erasmus MC, Rotterdam, the Netherlands.
ESMO Open. 2022 Dec;7(6):100600. doi: 10.1016/j.esmoop.2022.100600. Epub 2022 Oct 17.
The incidence of melanoma is increasing and 37% of patients with metastatic melanoma eventually have brain metastasis (BM). Currently, there is no consensus on screening for BM in patients with resected stage III melanoma. However, given the high incidence of BM, routine screening magnetic resonance imaging (MRI) of the brain is considered in patients with completely resected stage III melanoma before the start of adjuvant treatment. The aim of this study was to assess the yield of screening for BM in these patients.
A single-center cohort study was carried out in the Erasmus MC, Rotterdam, The Netherlands, a large tertiary referral center for patients with melanoma. Eligible patients with complete resection of stage III melanoma and a screening MRI of the brain, made within 12 weeks after resection and before adjuvant treatment (programmed cell death protein 1 inhibitors, dabrafenib-trametinib), available between 1 August 2018 and 1 January 2021, were included.
A total of 202 patients were included. Eighteen (8.9%) of 202 patients had extracranial metastasis at screening. Two (1.1%) of the remaining 184 patients had BM at screening, resulting in a switch from adjuvant treatment to ipilimumab-nivolumab. At a median follow-up of 21.2 months, BM was detected in another 4 (2.4%) of 166 patients who started with adjuvant treatment.
The yield of screening MRI of the brain is low after complete resection of stage III melanoma, before the start of adjuvant treatment. Therefore, routine screening MRI is not recommended in this setting.
黑色素瘤的发病率正在增加，37%的转移性黑色素瘤患者最终会发生脑转移（BM）。目前，对于接受手术切除的 III 期黑色素瘤患者，是否进行 BM 筛查尚无共识。然而，鉴于 BM 的高发生率，在开始辅助治疗之前，对于完全切除 III 期黑色素瘤的患者，考虑对其进行常规的脑磁共振成像（MRI）筛查。本研究旨在评估这些患者进行 BM 筛查的效果。
在荷兰鹿特丹伊拉斯谟大学医学中心（Erasmus MC）进行了一项单中心队列研究，该中心是黑色素瘤患者的大型三级转诊中心。本研究纳入了符合条件的患者，这些患者接受了完全切除 III 期黑色素瘤的手术，并且在手术切除后 12 周内、在开始辅助治疗（程序性细胞死亡蛋白 1 抑制剂、达拉非尼联合曲美替尼）之前，进行了脑 MRI 筛查。这些患者的筛查 MRI 结果可获取，时间范围为 2018 年 8 月 1 日至 2021 年 1 月 1 日。
共纳入 202 例患者。在筛查时，18 例（8.9%）患者有颅外转移。在其余 184 例患者中，有 2 例（1.1%）患者在筛查时发生 BM，导致从辅助治疗改为伊匹单抗联合纳武利尤单抗治疗。在 21.2 个月的中位随访期内，开始接受辅助治疗的 166 例患者中又有 4 例（2.4%）发现 BM。
在开始辅助治疗之前，对完全切除 III 期黑色素瘤后的患者进行脑 MRI 筛查的效果较低。因此，在这种情况下不推荐常规进行脑 MRI 筛查。
