Melanoma remains a formidable challenge in oncology, causing the majority of skin cancer deaths in the United States, with brain metastases contributing substantially to this mortality. This paper reviews the current therapeutic strategies for melanoma brain metastases, with a focus on delayed and concurrent stereotactic radiosurgery (SRS). While surgery and traditional chemotherapy offer limited efficacy, recent advances in immunotherapy, particularly immune checkpoint inhibitors (ICIs), have played a major role in the advancement and improved efficacy of the treatment of cancers, including brain metastases. Recent studies indicate that monotherapy with ICIs may lead to a higher median overall survival compared to historical benchmarks, potentially allowing patients to delay radiosurgery. Other studies have found that combining SRS with ICIs demonstrates promise, with results indicating improved intracranial control. Ongoing clinical trials explore novel combinations of immunotherapies and radiotherapies, aiming to optimize treatment outcomes while minimizing adverse effects. As treatment options expand, future studies will be necessary to understand the interplay between therapies and their optimal sequencing to improve patient outcomes.
黑色素瘤仍是肿瘤学领域的一大严峻挑战，在美国导致绝大多数皮肤癌死亡病例，其中脑转移是造成该死亡率的重要因素。本文综述了当前黑色素瘤脑转移的治疗策略，重点关注延迟性与同期立体定向放射外科治疗。虽然手术和传统化疗效果有限，但近年来免疫治疗特别是免疫检查点抑制剂的进展，在包括脑转移瘤在内的癌症治疗进步与疗效提升中发挥了重要作用。最新研究表明，与历史基准相比，免疫检查点抑制剂单药治疗可能延长患者中位总生存期，或可使患者推迟接受放射外科治疗。其他研究发现，立体定向放射外科联合免疫检查点抑制剂显示出良好前景，研究数据显示该联合疗法能改善颅内病灶控制。目前正在进行的临床试验探索免疫疗法与放射疗法的新型组合方案，旨在优化治疗效果的同时最大限度减少不良反应。随着治疗选择的扩展，未来需要进一步研究不同疗法之间的相互作用及其最佳序贯方案，以改善患者预后。
Delayed and Concurrent Stereotactic Radiosurgery in Immunotherapy-Naïve Melanoma Brain Metastases
肿瘤(癌症)患者之家