Abstract：
With improved systemic treatment and prolonged survival even with metastatic disease, diagnosing, treating, and monitoring brain metastases has become a central topic in the care of patients with melanoma. Patients with brain metastases from melanoma are typically excluded from pivotal clinical trials. When allowed, inclusion and exclusion criteria are rather selective and do not reflect the larger population of melanoma patients with brain metastases who frequently present with neurological symptoms and signs and require steroid medications. Moreover, the lack of consensus on reporting symptomatic brain involvement complicates the interpretation and implications of trial results for the overall population of patients with melanoma and brain metastasis. Here, we review the evidence regarding brain metastasis from melanoma and discuss the challenges of longitudinal neurological clinical assessments, including tools to capture cognition and quality of life. Finally, we propose the adoption of standardized tools to interpret neurological deficits in patients with melanoma and brain metastases and to assess the neurological status in the context of clinical trials.
摘要：
通过改善全身治疗和延长生存期，即使是转移性疾病，诊断,治疗,监测脑转移已成为治疗黑色素瘤患者的中心话题。患有黑色素瘤脑转移的患者通常被排除在关键的临床试验之外。如果允许,纳入和排除标准是相当有选择性的,不能反映患有脑转移的黑色素瘤患者的更多人群,这些患者经常出现神经系统症状和体征,需要使用类固醇药物.此外，在报告有症状的脑受累方面缺乏共识,这使得研究结果对黑色素瘤和脑转移患者总体人群的解释和意义复杂化.这里,我们回顾了有关黑色素瘤脑转移的证据，并讨论了纵向神经临床评估的挑战，包括捕捉认知和生活质量的工具。最后,我们建议采用标准化工具来解释黑色素瘤和脑转移患者的神经功能缺损,并在临床试验中评估神经系统状况.
