title: Radiation necrosis mimicking rapid intracranial progression of melanoma metastasis in two patients treated with vemurafenib.
abstract: Optimal treatment of metastases to the central nervous system (CNS) in patients with malignant melanoma remains a clinical challenge. In particular, for patients with BRAF-mutant melanoma and CNS metastases, much remains unknown about the safety and efficacy of the novel BRAF-targeted agents when administered in close sequence with radiation. We report two cases of rapid development of CNS radiation necrosis in patients with metastatic melanoma treated with the BRAF inhibitor, vemurafenib, closely sequenced with stereotactic radiosurgery or fractionated stereotactic radiation therapy. In the absence of prospective safety data from clinical trials, we advise vigilance in monitoring patients with BRAF-mutant melanoma whose treatment plan includes CNS radiation and vemurafenib and caution when assessing treatment response within the CNS in these patients.
authors.affiliation: aDepartment of Internal Medicine, Division of Medical Oncology Departments of bBiomedical Informatics cRadiation Oncology dNeurology eNeurologic Surgery fPathology, The Ohio State University gDepartment of Radiology, Division of Diagnostic Radiology, The Ohio State University, Columbus, Ohio, USA.
authors.forename: David A
authors.initials: DA
authors.lastname: Liebner
authors.forename: Steven A
authors.initials: SA
authors.lastname: Walston
authors.forename: Robert
authors.initials: R
authors.lastname: Cavaliere
authors.forename: Ciaran J
authors.initials: CJ
authors.lastname: Powers
authors.forename: Eric
authors.initials: E
authors.lastname: Sauvageau
authors.forename: Norman L
authors.initials: NL
authors.lastname: Lehman
authors.forename: Hasel
authors.initials: H
authors.lastname: Wayne Slone
authors.forename: Meng
authors.initials: M
authors.lastname: Xu-Welliver
authors.forename: Fen
authors.initials: F
authors.lastname: Xia
authors.forename: Kari L
authors.initials: KL
authors.lastname: Kendra
mesh_terms: D000328:Adult; D002490:Central Nervous System / Q000187:drug effects / Q000473:pathology* / Q000528:radiation effects; D003937:Diagnosis, Differential; D018450:Disease Progression; D018572:Disease-Free Survival; D005260:Female; D006801:Humans; D007211:Indoles / Q000009:adverse effects* / Q000627:therapeutic use*; D008297:Male; D008545:Melanoma / Q000175:diagnosis / Q000188:drug therapy* / Q000473:pathology / Q000532:radiotherapy*; D009154:Mutation; D009336:Necrosis / Q000175:diagnosis; D011829:Radiation Dosage; D011832:Radiation Injuries / Q000139:chemically induced / Q000209:etiology*; D012878:Skin Neoplasms / Q000175:diagnosis / Q000188:drug therapy* / Q000473:pathology / Q000532:radiotherapy*; D013449:Sulfonamides / Q000009:adverse effects* / Q000627:therapeutic use*; D000077484:Vemurafenib; D055815:Young Adult
chemical_list: D007211:Indoles; D013449:Sulfonamides; D000077484:Vemurafenib