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Case Reports
. 2015 Dec 18;7(12):e417.
doi: 10.7759/cureus.417.

High-Dose Radiation as a Dramatic, Immunological Primer in Locally Advanced Melanoma

Majid Mohiuddin  1 , Harold Park  1 , Sigrun Hallmeyer  2 , Jon Richards  2
Affiliations
Case Reports

High-Dose Radiation as a Dramatic, Immunological Primer in Locally Advanced Melanoma

Majid Mohiuddin et al. Cureus. .

Abstract

A 53-year-old white male presented with a right axillary melanoma that became widely metastatic and progressive despite multiple systemic treatments. He became refractory to ipilimumab (Yervoy) and pembrolizumab (Keytruda). He presented with a very large, painful left posterior neck mass that was 18 x 15 x 8 cm in size clinically. He was treated with a single fraction of 20 Gy using parallel opposed, spatially fractionated GRID radiation therapy (SFGRT), along with concurrent pembrolizumab. He also received 50 Gy in 25 fractions of conventional radiation. After five months of concurrent treatment, the refractory neck mass had completely resolved and he had no lasting side effects. Our dramatic case confirms the synergistic effect of high-dose GRID radiation as a primer for renewed, enhanced immunological response, and we have used this approach successfully on a number of similar patients with rapid and durable results.

Keywords: immunotherapy; ipilimumab; metastatic melanoma; pembrolizumab; spatially fractionated radiation therapy (grid).

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Conflict of interest statement

The authors have declared that no competing interests exist.

Figures

Figure 1
Figure 1. Initial Tumor on Neck
The initial tumor on the left posterior neck of 18 x 15 x 8 cm size, demarcated by wire.
Figure 2
Figure 2. Radiation Dosimetry with GRID
The initial tumor (red line) treated by GRID radiation of 20 Gy (yellow lines) in the A) axial, B) coronal, and C) 3-dimensional view with GRID blocks shown.
Figure 3
Figure 3. Tumor Response to Treatment
The tumor is completely gone 5 months later clinically and on CT scan.
See this image and copyright information in PMC

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