Gamma Knife Radiosurgery for Metastatic Brain Tumors from Malignant Melanomas: A Japanese Multi-Institutional Cooperative and Retrospective Cohort Study (JLGK1501)

Matsunaga, Shigetaka; Shuto, Takashi; Yamamoto, Masaaki; Yomo, Shoji; Kondoh, Takeshi; Kobayashi, Tatsuya; Sato, Manabu; Okamoto, Hisayo; Serizawa, Toru; Nagano, Osamu; Kenai, Hiroyuki; Obara, Takuma; Iwai, Yoshiyasu; Yasuda, Seiji; Hasegawa, Toshinori; Kubo, Kenji; Shidoh, Satoka; Mori, Katsuharu; Hayashi, Motohiro; Inoue, Akira; Onoue, Shinji; Gondo, Masazumi

doi:10.1159/000489948

Cited by 16 publications

(10 citation statements)

References 44 publications

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“…The generalization of SRS may have improved the median OS. The effectiveness of SRS has also been reported in other malignancies, such as renal cell carcinoma 38 and malignant melanoma 39 . Regarding sarcomas, SRS was performed in 5.9%–15% of patients with BM 2,3,7,10 .…”

Section: Discussionmentioning

confidence: 84%

“…The effectiveness of SRS has also been reported in other malignancies, such as renal cell carcinoma 38 and malignant melanoma. 39 Regarding sarcomas, SRS was performed in 5.9%–15% of patients with BM. 2 , 3 , 7 , 10 In our study, SRS was performed in 25% of patients, showing a higher frequency than in previous reports, and was significantly correlated with a better prognosis.…”

Section: Discussionmentioning

confidence: 99%

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A retrospective analysis of the prognosis of Japanese patients with sarcoma brain metastasis

Toda¹,

Kobayashi²,

Kubota

et al. 2023

Cancer Medicine

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Background Bone and soft tissue sarcomas are rare tumors and extremely rarely metastasize to the brain. Previous studies have examined the characteristics and poor prognostic factors in cases of sarcoma brain metastasis (BM). Due to the rarity of cases of BM from sarcoma, limited data exist concerning the prognostic factors and treatment strategies. Methods A retrospective single‐center study was performed on sarcoma patients with BM. The clinicopathological characteristics and treatment options for BM of sarcoma were investigated to identify predictive prognostic factors. Results Between 2006 and 2021, 32 patients treated for newly diagnosed BM at our hospital were retrieved among 3133 bone and soft tissue sarcoma patients via our database. The most common symptom was headache (34%), and the most common histological subtypes were alveolar soft part sarcoma (ASPS) and undifferentiated pleomorphic sarcoma (25%). Non‐ASPS ( p = 0.022), presence of lung metastasis ( p = 0.046), a short duration between initial metastasis, and the diagnosis of brain metastasis ( p = 0.020), and the absence of stereotactic radiosurgery for BM ( p = 0.0094) were significantly correlated with a poor prognosis. Conclusions In conclusion, the prognosis of patients with brain metastases of sarcomas is still dismal, but it is necessary to be aware of the factors associated with a relatively favorable prognosis and to select treatment options appropriately.

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Section: Discussionmentioning

confidence: 84%

Section: Discussionmentioning

confidence: 99%

A retrospective analysis of the prognosis of Japanese patients with sarcoma brain metastasis

Toda¹,

Kobayashi²,

Kubota

et al. 2023

Cancer Medicine

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“…Previous studies of Asian patients with MBMs showed a median OS of 7-8 months, which is comparable to our findings. 11,12 Although previous studies have shown limited effectiveness of ICI and TT in Asian patients with unresectable melanoma, Asian patients with MBMs may also respond poorly to these systemic therapies. 8 The associated factors identified in multivariate analysis were primary location, serum LDH levels, type of initial systemic therapy, and type of radiotherapy.…”

Section: Discussionmentioning

confidence: 99%

“…Our study demonstrated that patients treated with STI had longer survival than those treated with WBRT. Previous studies have demonstrated the effectiveness of STI over WBRT 11 . In general, STIs are preferred for up to four brain metastases 26 .…”

Section: Discussionmentioning

confidence: 99%

A single‐center retrospective analysis of prognoses in patients with melanoma brain metastases and effectiveness of treatment in Japan

Wada,

Ogata,

Kashihara

et al. 2023

Cancer Medicine

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BackgroundMelanoma brain metastasis (MBM) has a poor prognosis, although recent treatments, including immune checkpoint inhibitors and targeted therapy, have improved the prognosis. However, these systemic therapies have been reported to be less efficient for Asian patients. We investigated the survival of Asian patients with MBM and the effectiveness of systemic therapies.MethodsWe retrospectively reviewed the survival rates of patients diagnosed with MBM between January 2011 and December 2021 at the National Cancer Center Hospital in Tokyo, Japan. In addition, we identified factors associated with survival using Cox regression analysis.ResultsA total of 135 patients were included. The median overall survival (OS) after an MBM diagnosis was 7.8 months (95% confidence interval [CI] 6.1–9.6). The 6‐month and 1‐year survival rates were 60.7% and 34.8%, respectively. We identified the prognostic factors of MBM, including non‐acral primary location, low serum LDH levels, systemic therapy of single‐agent immune checkpoint inhibitors (ICIs) or targeted therapies (TTs), and radiotherapy of stereotactic irradiation (STI). We found no significant difference in effectiveness between single‐agent ICIs, the combination of Nivolumab and Ipilimumab (COMBI‐ICI), and TTs (COMBI‐ICI vs. single‐agent ICI, hazard ratio 0.71, 95% confidence interval 0.27–1.88, p = 0.49; COMBI‐ICI vs. TT: hazard ratio 0.46, 95% confidence interval 0.14–1.55, p = 0.21).ConclusionsSystemic therapy and radiotherapy have improved the survival of MBM patients, but the survival of Asian patients remains poor. Our findings suggest that COMBI‐ICIs are not significantly more effective than single‐agent ICI or TT in treating MBM.

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“…9 While the local control rate of multi-agent ICI is encouraging, it is important to remem-ber that the 57% rate remains vastly inferior to the six-month local control rates of 87-91% achieved following single-fraction SRS administered via linear accelerator or Gamma Knife. 6,[10][11][12] Candidates for SRS are typically patients with 1-10 brain metastases, while patients exceeding 10 brain metastases often receive WBRT instead of SRS. 13 1.3.…”

Section: Treatment Of Brain Metastasesmentioning

confidence: 99%

Radiosurgery dose reduction for brain metastases on immunotherapy (RADREMI): A prospective phase I study protocol

McClelland

Lautenschlaeger

Zang

et al. 2020

Reports of Practical Oncology & Radiotherapy

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Introduction: Up to 20% of patients with brain metastases treated with immune checkpoint inhibitor (ICI) therapy and concomitant stereotactic radiosurgery (SRS) suffer from symptomatic radiation necrosis. The goal of this study is to evaluate Radiosurgery Dose Reduction for Brain Metastases on Immunotherapy (RADREMI) on six-month symptomatic radiation necrosis rates. Methods: This study is a prospective single arm Phase I pilot study which will recruit patients with brain metastases receiving ICI delivered within 30 days before SRS. All patients will be treated with RADREMI dosing, which involves SRS doses of 18 Gy for 0−2 cm lesions, 14 Gy for 2.1−3 cm lesions, and 12 Gy for 3.1−4 cm lesions. All patients will be monitored for six-month symptomatic radiation necrosis (defined as a six-month rate of clinical symptomatology requiring steroid administration and/or operative intervention concomitant with imaging findings consistent with radiation necrosis) and six-month local control. We expect that RADREMI dosing will significantly reduce the symptomatic radiation necrosis rate of concomitant SRS + ICI without significantly sacrificing the local control obtained by the present RTOG 90−05 SRS dosing schema. Local control will be defined according to the Response Assessment in Neuro-Oncology (RANO) criteria. Discussion: This study is the first prospective trial to investigate the safety of dose-reduced SRS in treatment of brain metastases with concomitant ICI. The findings should provide fertile soil for future multi-institutional collaborative efficacy trials of RADREMI dosing for this patient population.

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Gamma Knife Radiosurgery for Metastatic Brain Tumors from Malignant Melanomas: A Japanese Multi-Institutional Cooperative and Retrospective Cohort Study (JLGK1501)

Cited by 16 publications

References 44 publications

A retrospective analysis of the prognosis of Japanese patients with sarcoma brain metastasis

A retrospective analysis of the prognosis of Japanese patients with sarcoma brain metastasis

A single‐center retrospective analysis of prognoses in patients with melanoma brain metastases and effectiveness of treatment in Japan

Radiosurgery dose reduction for brain metastases on immunotherapy (RADREMI): A prospective phase I study protocol

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