The frequency of brain metastasis (BM) is up to 45-50% in patients with advanced melanoma. Our aim was to identify the risk factors for the early occurrence of BM.A total of 333 patients with BM were identified from our database of 2,972 patients with melanoma between 2003-2015.The median elapsed time to BM (TTBM) was significantly associated with Breslow thickness, ulceration, location, and patient age. Head and neck location was the strongest predictor for early BM development [hazard ratio (HR)=1.81, 95% confidence interval (CI)=1.05-3.12; p=0.031) followed by Breslow thickness >2 mm (HR=1.53, 95% CI=1.04-2.23; p=0.027). Body part-specific median TTBM was 51.5, 43, 38.5, 32, 35, 36.5, 35.5 and 19 months in leg-foot, thigh, abdomen-pelvic, chest-back, lower arm-hand, upper arm-shoulder, face-neck and scalp regions, respectively.We suggest brain magnetic resonance imaging follow-up in the high-risk patient group of patients with melanoma in the head and neck region, especially for those with primary melanoma over Breslow 2 mm located in the scalp.
First-line treatment of panitumumab (Pmab) plus FOLFOX or Pmab plus FOLFIRI demonstrated improved outcomes in patients with wild-type-KRAS metastatic colorectal cancer (CRC) and liver-limited disease.
We report a case of a 41 year-old man with a KRAS wild type CRC with multiple liver metastases who received first-line Pmab plus FOLFOX4 in 2014. After 5 cycles, remarkable tumor shrinkage was observed in the liver as only one reduced sized metastasis could be detected. Liver metastasectomy and after a definitive radiotherapy for the primary tumor, rectosigmoideal resection were performed. Half, then one year later two more liver metastasectomies were needed because of recurrency of the liver lesions.
The patient has been tumor-free for 1.5 years due to the first-line Pmab plus FOLFOX4 treatment followed by well decided surgical resections. We consider this case as a successful treatment with a 40 months follow-up, exceeding the literature median OS data of 23.9 months.
Psychological problems may arise in connection with oncomedical treatments in three ways: 1. acute and/or 2. chronic ways, as well as 3. co-morbid psychiatric diseases that already exist must also be taken into account. Immunotherapies have the most common and also clinically relevant psychological side effects. Fatigue, anhedonia, social isolation, psychomotor slowness is reported during treatment. Anti-CTLA-4 antibody (ipilimumab) immunotherapy can present one of the most modern opportunities for adequate treatment for patients having distant metastasis or unresectable tumour. In relation to immunotherapies, acute psychological side effects (acute stress) emerging during treatments develop in a way that can mostly be linked to environmental factors, e.g. notification of diagnosis, hospitalisation, progression, deterioration in quality of life, imminent dates of control. Crisis is a temporary and threatening condition that endangers psychological balance. In such conditions, enhanced psychological vulnerability must be taken into account and doctors play a key role in the rapid recognition of the condition. Chronic psychological problems, which may arise from the depressogenic effect of the applied treatment or originated from a pre-melanoma psychiatric condition, may exceed the diagnostic and psychotherapeutic competences of a clinical psychologist. Even in case of a well-defined depressogenic biological mechanism such as the activation of the pro-inflammatory cytokine pathway, positive environmental effects can reduce symptoms and thus increase compliance. Side effects can be treated successfully using psychotherapeutic methods and/or psychiatric medicines. The application of routinely used complex psychosocial screening packages can provide the easiest method to identify worsening psychological condition during immunotherapy and give rapid feedback to the oncologist and the patient. Team work is of particular importance in a situation like this as it requires complex, interdisciplinary and high-level professional collaboration. Multidisciplinarity is the basic framework for modern tumour therapy where, under the guidance of oncologists, the work of specialist nurses, social workers, physiotherapists, dieticians and last but not least psychiatrists/psychologists are indispensable and play a significant role.A melanoma malignum korszerû kezelésében az immunterápiás modalitások a betegség különbözõ stádiumaiban egyre jelentõsebb szerepet kapnak. Mind a betegség okozta környezeti tényezõk okán többnyire akutan megjelenõ szorongás, mind a biológiai hátterû pszichoneuroimmunológiai hatásmechanizmusokon keresztül eszkalálódó depresszió az elhúzódó orvosi kezelések során az életminõség jelentõs romlását és emiatt sokszor a terápiahûség elvesztését eredményezik. A kezelések pszichológiai mellékhatásai megfelelõ körültekintéssel történõ pszichoszociális szûréssel, team-munkában végzett együttmûködés által idõben és adekvát módon megelõzhetõk, a medikális kezelések során pedig jól kézben tarthatók és kezelhetõk.
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