Intracranial Hemorrhage in Patients with Metastatic Melanoma Treated by Gamma Knife Radiosurgery

Klein, Thomas; Barbiero, Fabiano; Bond, J.; Knisely, Jonathan; Chiang, Veronica; Yu, Janet

doi:10.1016/j.ijrobp.2011.06.1795

Cited by 2 publications

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“…Nevertheless, the limited follow-up duration of our study precludes a complete assessment of radionecrosis incidence, which continues to occur over 12 months after radiotherapy [ 26 ]. Our institutional rate of post-WBRT intralesional hemorrhage is also consistent with a retrospective study performed by Klein et al, which reported a 31% rate of post-radiosurgery intralesional hemorrhage [ 27 ]. Reassuringly, neither the development of radionecrosis nor hemorrhage contributed to worsened OS or PFS, although the presence of intralesional hemorrhage significantly decreased DFFS.…”

Section: Discussionsupporting

confidence: 91%

Single institutional outcomes of whole brain radiotherapy for metastatic melanoma brain metastases

2021

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Background The management of melanoma with brain metastases (MBM) is increasingly complex, especially given recent improvements in targeted agents, immunotherapy, and radiotherapy. Whole brain radiation therapy (WBRT) is a longstanding radiotherapy technique for which reported patient outcomes and experiences are limited. We sought to report our institutional outcomes for MBM patients receiving WBRT and assess whether other clinical factors impact prognosis. Methods A retrospective review of a single institution database was performed. Patients diagnosed with MBM from 2000 to 2018 treated with WBRT, with or without other systemic treatments, were included. Post-WBRT brain MRI scans were assessed at timed intervals for radiographic response. Clinical and treatment variables associated with overall survival (OS), distant failure-free survival (DFFS), local failure-free survival (LFFS), and progression-free survival (PFS) were assessed. Data on radiation-induced side effects, including radionecrosis, hemorrhage, and memory deficits, was also captured. Results 63 patients with MBM were ultimately included in our study. 69% of patients had 5 or more brain metastases at the time of WBRT, and 68% had extracranial disease. The median dose of WBRT was 30 Gy over 10 fractions. Median follow-up was 4.0 months. Patients receiving WBRT had a median OS of 7.0 months, median PFS of 2.2 months, median DFFS of 6.1 months, and median LFFS of 4.9 months. Performance status correlated with OS on both univariate and multivariable analysis. BRAF inhibitor was the only systemic therapy to significantly impact OS on univariate analysis (HR 0.24, 95% CI 0.07–0.79, p = 0.019), and this effect extended to multivariable analysis as well. Post-WBRT intralesional hemorrhage decreased DFFS on both univariate and multivariable analysis. Of patients with post-treatment brain scans available, there was a 16% rate of radionecrosis, 32% rate of hemorrhage, and 19% rate of memory deficits. Conclusions Outcomes for MBM patients receiving WBRT indicate that WBRT remains an effective treatment strategy to control intracranial disease. Treatment-related toxicities such as intralesional hemorrhage, necrosis, or neurocognitive side effects are limited. With continued innovations in WBRT technique and systemic therapy development, MBM outcomes may continue to improve. Further trials should evaluate the role of WBRT in the modern context.

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Section: Discussionsupporting

confidence: 91%

Single institutional outcomes of whole brain radiotherapy for metastatic melanoma brain metastases

2021

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“…[26] Our institutional rate of post-WBRT intralesional hemorrhage is also consistent with a retrospective study performed by Klein et al, which reported a 31% rate of post-radiosurgery intralesional hemorrhage. [27] Reassuringly, neither the development of radionecrosis nor hemorrhage contributed to worsened OS or PFS, although the presence of intralesional hemorrhage signi cantly decreased DFFS. This correlation could be related in part to limitations in radiographic sensitivity in discerning between blood products and disease progression.…”

Section: Overall Outcomesmentioning

confidence: 96%

Single Institutional Outcomes of Whole Brain Radiotherapy for Metastatic Melanoma Brain Metastases

Jiang

Kleber

Switchenko

2020

Preprint

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Background: The management of melanoma with brain metastases (MBM) is increasingly complex, especially given recent improvements in targeted agents, immunotherapy, and radiotherapy. Whole brain radiation therapy (WBRT) is a longstanding radiotherapy technique for which reported patient outcomes and experiences are limited. We sought to report our institutional outcomes for MBM patients receiving WBRT and assess whether other clinical factors impact prognosis. Methods: A retrospective review of a single institution database was performed. Patients diagnosed with MBM from 2000-2018 treated with WBRT, with or without other systemic treatments, were included. Post-WBRT brain MRI scans were assessed at timed intervals for radiographic response. Clinical and treatment variables associated with overall survival (OS), distant failure-free survival (DFFS), local failure-free survival (LFFS), and progression-free survival (PFS) were assessed. Data on radiation-induced side effects, including radionecrosis, hemorrhage, and memory deficits, was also captured. Results: 63 patients with MBM were ultimately included in our study. 69% of patients had 5 or more brain metastases at the time of WBRT, and 68% had extracranial disease. The median dose of WBRT was 30 Gray over 10 fractions. Median follow-up was 4.0 months. Patients receiving WBRT had a median OS of 7.0 months, median PFS of 2.2 months, median DFFS of 6.1 months, and median LFFS of 4.9 months. Performance status correlated with OS on both univariate and multivariable analysis. BRAF inhibitor was the only systemic therapy to significantly impact OS on univariate analysis (HR 0.24, 95% CI 0.07-0.79, p=0.019), and this effect extended to multivariable analysis as well. Post-WBRT intralesional hemorrhage decreased DFFS on both univariate and multivariable analysis. Of patients with post-treatment brain scans available, there was a 16% rate of radionecrosis, 32% rate of hemorrhage, and 19% rate of memory deficits.Conclusions: Outcomes for MBM patients receiving WBRT indicate that WBRT remains an effective treatment strategy to control intracranial disease. Treatment-related toxicities such as intralesional hemorrhage, necrosis, or neurocognitive side effects are limited. With continued innovations in WBRT technique and systemic therapy development, MBM outcomes may continue to improve. Further trials should evaluate the role of WBRT in the modern context.

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Intracranial Hemorrhage in Patients with Metastatic Melanoma Treated by Gamma Knife Radiosurgery

Cited by 2 publications

References 0 publications

Single institutional outcomes of whole brain radiotherapy for metastatic melanoma brain metastases

Single institutional outcomes of whole brain radiotherapy for metastatic melanoma brain metastases

Single Institutional Outcomes of Whole Brain Radiotherapy for Metastatic Melanoma Brain Metastases

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