title: Symptomatic Histologically Proven Necrosis of Brain following Stereotactic Radiation and Ipilimumab in Six Lesions in Four Melanoma Patients.
abstract: Four cases previously treated with ipilimumab with a total of six histologically confirmed symptomatic lesions of RNB without any sign of active tumour following stereotactic irradiation of MBM are reported. These lesions were all originally thought to be disease recurrence. In two cases, ipilimumab was given prior to SRT; in the other two ipilimumab was given after SRT. The average time from first ipilimumab to RNB was 15 months. The average time from SRT to RNB was 11 months. The average time from first diagnosis of MBM to last follow-up was 20 months at which time three patients were still alive, one with no evidence of disease. These cases represent approximately three percent of the total cases of melanoma and ten percent of those cases treated with ipilimumab irradiated in our respective centres collectively. We report this to highlight this new problem so that others may have a high index of suspicion, allowing, if clinically warranted, aggressive surgical salvage, possibly resulting in increased survival. Further studies prospectively collecting data to understand the denominator of this problem are needed to determine whether this problem is just the result of longer survival or whether there is some synergy between these two modalities that are increasingly being used together.
authors.affiliation: Neurosurgery, UZ Brussel, Campus Jette, Laarbeeklaan 101, 1090 Brussels, Belgium ; Medical Oncology, UZ Brussel, Campus Jette, Laarbeeklaan 101, 1090 Brussels, Belgium.
authors.forename: Stephanie
authors.identifier: 0000-0002-9406-2274
authors.initials: S
authors.lastname: Du Four
authors.affiliation: Melanoma Institute Australia, Poche Centre, 40 Rocklands Road, Sydney, NSW 2060, Australia.
authors.forename: Angela
authors.initials: A
authors.lastname: Hong
authors.affiliation: Crown Princess Mary Cancer Centre Westmead, University of Sydney, Sydney, NSW 2060, Australia.
authors.forename: Matthew
authors.initials: M
authors.lastname: Chan
authors.affiliation: Medical Oncology, Royal Darwin Hospital, 105 Rocklands Drive, Tiwi, Darwin, NT 0810, Australia.
authors.forename: Michail
authors.identifier: 0000-0003-0791-203X
authors.initials: M
authors.lastname: Charakidis
authors.affiliation: Neurosurgery, UZ Brussel, Campus Jette, Laarbeeklaan 101, 1090 Brussels, Belgium.
authors.forename: Johnny
authors.identifier: 0000-0001-9869-9806
authors.initials: J
authors.lastname: Duerinck
authors.affiliation: Medical Oncology, UZ Brussel, Campus Jette, Laarbeeklaan 101, 1090 Brussels, Belgium.
authors.forename: Sofie
authors.initials: S
authors.lastname: Wilgenhof
authors.affiliation: Radiation Oncology, University of Sydney, Edward Ford Building, Physics Road, Camperdown, Sydney, NSW 2006, Australia.
authors.forename: Wei
authors.initials: W
authors.lastname: Wang
authors.affiliation: Westmead Clinical School, University of Sydney, Cnr Hawkesbury Road & Darcy Road, Westmead, NSW 2145, Australia.
authors.forename: Linda
authors.identifier: 0000-0003-0704-9918
authors.initials: L
authors.lastname: Feng
authors.affiliation: Neuropathology, UZ Brussel, Campus Jette, Laarbeeklaan 101, 1090 Brussels, Belgium.
authors.forename: Alex
authors.initials: A
authors.lastname: Michotte
authors.affiliation: Medical Oncology, Royal Darwin Hospital, 105 Rocklands Drive, Tiwi, Darwin, NT 0810, Australia.
authors.forename: Meena
authors.identifier: 0000-0002-0027-5798
authors.initials: M
authors.lastname: Okera
authors.affiliation: Department of Neurosurgery, Mater Hospital, 25 Rocklands Road, Crows Nest, NSW 2060, Australia.
authors.forename: Brindha
authors.initials: B
authors.lastname: Shivalingam
authors.affiliation: Department of Radiation Oncology, Mater Hospital, 25 Rocklands Road, Crows Nest, NSW 2060, Australia.
authors.forename: Gerald
authors.identifier: 0000-0002-0764-578X
authors.initials: G
authors.lastname: Fogarty
authors.affiliation: Crown Princess Mary Cancer Centre Westmead, University of Sydney, Sydney, NSW 2060, Australia.
authors.forename: Richard
authors.initials: R
authors.lastname: Kefford
authors.affiliation: Medical Oncology, UZ Brussel, Campus Jette, Laarbeeklaan 101, 1090 Brussels, Belgium.
authors.forename: Bart
authors.identifier: 0000-0003-0658-5903
authors.initials: B
authors.lastname: Neyns
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