The Role of Radiotherapy in the Management of Melanoma Brain Metastases: An Overview.

Opinion statement: Clinical management of melanoma brain metastases is complex and requires multidisciplinary approach. With close collaboration between neurosurgeons, radiation oncologists and medical oncologists, melanoma patients with brain are offered different treatment modalities: surgery, radiation therapy, systemic therapy or combined treatments. Radiation therapy (whole brain radiotherapy- WBRT and stereotactic radiosurgery- SRS) is an integral part of treating melanoma brain metastases. Use of immunotherapy (checkpoint inhibitors) and targeted therapy (BRAF/MEK inhibitors) significantly changed the outcome in patients with melanoma metastases. Currently, ipilimumab and nivolumab (COMBO) is the preferred first-line systemic therapy for all patients with asymptomatic brain metastases, regardless of BRAF status (BRAF wild-type and BRAF-mutated). Although at the moment there is no consensus on the concomitant use of SRS and COMBO, results from clinical trials suggest that this combined treatment modality should be considered the standard of care for melanoma patients with brain metastases. However, further clinical research is required to define optimal treatment modalities for routine management of melanoma brain lesions.