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Intracranial response after extracranial radiation in a patient with rapidly progressing metastatic melanoma
  1. Oliver Piercey1,
  2. Jonathan Mark Tomaszewski2 and
  3. Kortnye Smith1,3
  1. 1Department of Medical Oncology, Peter MacCallum Cancer Centre, Parkville, Victoria, Australia
  2. 2Ballarat Austin Radiation Oncology Centre, Ballarat Health Services, Ballarat, Victoria, Australia
  3. 3Ballarat Regional Integrated Cancer Centre, Ballarat Health Services, Ballarat, Victoria, Australia
  1. Correspondence to Dr Oliver Piercey; opiercey{at}gmail.com

Abstract

Growing literature supports the synergistic effect of radiation as a primer for renewed enhanced systemic immunological responses in patients receiving immunotherapy for metastatic melanoma. Radiographic regression of extracranial tumours after treatment of intracranial metastatic lesions has been reported and these observations point to an abscopal effect that traverses the blood–brain barrier. We describe a patient with rapidly progressing metastatic melanoma despite combined immune checkpoint blockade, who achieved a complete metabolic response of both his extracranial and intracranial disease after the commencement of palliative radiation to his axilla. This is the first published case, to our knowledge, of a sustained, complete intracranial abscopal response from extracranial radiation. We discuss potential mechanistic relations between radiation, the blood–brain barrier and the abscopal effect.

  • skin cancer
  • radiotherapy
  • immunology

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Footnotes

  • Twitter @opiercey

  • Contributors OP wrote the case report including the literature review and approved the final version. JMT is the patient’s treating medical specialist, contributed to the manuscript and approved the final version. KS is the patient’s treating medical specialist, contributed to writing the manuscript and approved the final version.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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