鼻腔黏膜黑色素瘤合并脑转移病例分析  

Case analysis of sinonasal mucosal melanoma with brain metastases

作　　者：白连伟[1] 杨焱[1] 邢德君[1] Bai Lianwei;Yang Yan;Xing Dejun(Department of Renal Cancer and Melanoma,Jilin Cancer Hospital,Changchun 130012,China)

机构地区：[1]吉林省肿瘤医院肾癌黑色素瘤内三科,长春130012

出　　处：《中华转移性肿瘤杂志》2023年第3期251-255,共5页Chinese Journal of Metastatic Cancer

摘　　要：目的鼻腔黏膜黑色素瘤(SNMM)发病罕见, 发生脑转移后治疗手段有限, 预后极差。本研究旨在探讨SNMM伴有脑转移患者的有效治疗手段。方法收集吉林省肿瘤医院治疗的1例SNMM患者, 分析其临床和病理学特征, 以及出现脑转移后的治疗方法, 并复习相关文献。结果本病例为中年男性患者, 初诊时给予手术治疗, 术后行特瑞普利单抗辅助免疫治疗1年, 疾病快速复发;1线给予达卡巴嗪联合恩度治疗, 疾病再次快速进展, 出现多发脑转移, 伴有显著的脑转移症状, 脑部放疗效果欠佳, 病情危重;2线给予特瑞普利单抗联合仑伐替尼及替莫唑胺治疗, 治疗后临床症状明显改善, 脑转移瘤显著缩小, 无进展生存时间为18个月, 总生存期46个月。结论免疫联合抗血管及化疗的治疗方法能够改善SNMM伴有脑转移患者的生活质量, 显著延长生存时间, 可为临床这类患者提供一种可借鉴的治疗策略。Objective Sinonasal mucosal melanoma(SNMM)is a rare disease with limited treatment and poor prognosis after brain metastases.The purpose of this study was to investigate the effective treatment of SNMM with brain metastases.Methods A case of SNMM treated in Jilin Cancer Hospital was collected to analyze its clinical and pathological features as well as the treatment methods after brain metastases,and the related literature was reviewed.Results This case was a middle-aged male patient who received surgical treatment at first diagnosis.After one year of adjuvant immunotherapy with Toripalimab,the disease recurred within a short time.The patient received Dacarbazine in combination with Endostatin as first-line therapy,and the disease again progressed rapidly with multiple brain metastases accompanied by significant clinical symptoms.The brain metastases were then treated with radiation,which was less effective,and the patient was in critical condition.The patient received Toripalimab combined with Lenvatinib and Temozolomide as second-line treatment.The clinical symptoms were significantly improved and the brain metastases were significantly reduced.Progression-free survival was 18 months and overall survival was 46 months.Conclusion The combination of immunotherapy with antiangiogenic therapy and chemotherapy can improve the quality of life and significantly prolong the survival time of SNMM with brain metastases,providing a referable treatment strategy for these patients.

关 键 词：脑转移/鼻腔黏膜黑色素瘤 免疫治疗 抗血管治疗 

分 类 号：R739.62[医药卫生—肿瘤]