The meaning of screening: detection of brain metastasis in the adjuvant setting for stage III melanoma

ESMO Open

article

S.H.A.E. Derks¹  K. de Joode²  E.E.A.P. Mulder²  L.S. Ho¹  A. Joosse²  M.J.A. de Jonge²  C. Verhoef⁴  D.J. Grünhagen⁴  M. Smits³  M.J. van den Bent¹  A.A.M. van der Veldt² 

[1] Department of Neuro-Oncology, Erasmus MC Cancer Institute;Department of Medical Oncology, Erasmus MC Cancer Institute;Department of Radiology & Nuclear Medicine;Department of Surgical Oncology, Erasmus MC Cancer Institute

关键词: brain metastasis;    melanoma;    stage III;    adjuvant treatment;    screening;    MRI of the brain;    nivolumab;    pembrolizumab;    dabrafenib–trametinib;   

DOI  :  10.1016/j.esmoop.2022.100600

学科分类：社会科学、人文和艺术（综合）

来源: BMJ Publishing Group

【 摘 要 】

Background 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.Materials and methods 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.Results 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.Conclusions 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.

【 授权许可】

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