Intracranial response after extracranial radiation in a patient with rapidly progressing metastatic melanoma

2021 ◽  
Vol 14 (6) ◽  
pp. e240921
Author(s):  
Oliver Piercey ◽  
Jonathan Mark Tomaszewski ◽  
Kortnye Smith

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.

2021 ◽  
Vol 22 (16) ◽  
pp. 8929
Author(s):  
Gaku Yamanaka ◽  
Shinji Suzuki ◽  
Natsumi Morishita ◽  
Mika Takeshita ◽  
Kanako Kanou ◽  
...  

Currently, migraine is treated mainly by targeting calcitonin gene-related peptides, although the efficacy of this method is limited and new treatment strategies are desired. Neuroinflammation has been implicated in the pathogenesis of migraine. In patients with migraine, peripheral levels of pro-inflammatory cytokines, such as interleukin-1β (IL-1β) and tumor necrosis factor-α, are known to be increased. Additionally, animal models of headache have demonstrated that immunological responses associated with cytokines are involved in the pathogenesis of migraine. Furthermore, these inflammatory mediators might alter the function of tight junctions in brain vascular endothelial cells in animal models, but not in human patients. Based on clinical findings showing elevated IL-1β, and experimental findings involving IL-1β and both the peripheral trigeminal ganglion and central trigeminal vascular pathways, regulation of the Il-1β/IL-1 receptor type 1 axis might lead to new treatments for migraine. However, the integrity of the blood-brain barrier is not expected to be affected during attacks in patients with migraine.


1995 ◽  
Author(s):  
Thomas P. Davis ◽  
Thomas J. Abbruscato ◽  
Elizabeth Brownson ◽  
Victor J. Hruby

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