Stereotactic Radiosurgery for Melanoma Brain Metastases: A Comprehensive Clinical Case Series

Feng, Rui; Oermann, Eric K.; Shrivastava, Raj; Gold, A. H.; Collins, Brian T.; Kondziolka, Douglas; Collins, Sean P.

doi:10.1016/j.wneu.2017.01.014

Cited by 12 publications

(9 citation statements)

References 25 publications

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“…Most notably, it also includes a molecular marker (BRAF) with profound impact on systemic treatment paradigms [ 8 ]. In line with Sperduto et al, other groups have shown that survival is longer if BRAF mutations are detectable [ 15 , 16 ]. The same result was obtained in the present study, albeit in a very small group of patients and therefore without statistical significance (P = 0.08).…”

Section: Discussionsupporting

confidence: 67%

Validation of the Graded Prognostic Assessment for Melanoma Using Molecular Markers (Melanoma-molGPA)

et al. 2018

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BackgroundIt has been suggested to replace the diagnosis-specific graded prognostic assessment (DS-GPA, based on performance status and number of brain metastases) for patients with primary malignant melanoma with the new Melanoma-molGPA. The latter is a more complex assessment, which also includes BRAF mutation status, age and extracranial metastases. To test the performance of the Melanoma-molGPA, we performed a validation study of this new survival prediction tool.MethodsA retrospective analysis of patients treated at two different academic institutions was performed. The four-tiered Melanoma-molGPA was calculated as suggested in the original study.ResultsMedian overall survival was 5.4 months (95% confidence interval: 3.1 - 7.7 months). Median survival in the four prognostic classes was 2.1, 7.8, 11.8, and 18.0 months, respectively. The 1-year survival rates were 3%, 25%, 43%, and 80%, respectively. The difference between the Kaplan-Meier curves was significant (P = 0.0001, log-rank test).ConclusionsThe present survival outcomes support the use of the Melanoma-molGPA. However, survival was better in each of the four groups in the original study. Possible reasons include lead-time bias and different treatment policies.

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Section: Discussionsupporting

confidence: 67%

Validation of the Graded Prognostic Assessment for Melanoma Using Molecular Markers (Melanoma-molGPA)

et al. 2018

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“…The 12-month local control rate with SRS is about 65% (85)(86)(87)(88). More impressively, SRS also contributes to improved overall survival from 4 months to 6-8 months as compared to WBRT (85,89,90). As a result, SRS alone should be considered the standard of care for patients with limited brain metastases (up to 10 brain metastases) and size suitable for SRS (usually ≤4 cm in diameter).…”

Section: Role Of Palliative Rt For Melanomasmentioning

confidence: 99%

Radiation Therapy for Melanoma

Shi

2017

Cutaneous Melanoma: Etiology and Therapy

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Although melanoma is a relative radioresistant tumor, radiation therapy (RT) remains a valid and effective treatment option for the management of melanoma. RT as a primary treatment is often offered in well-defined situations, such as medical inoperability, lentiginous melanoma, mucosal melanoma, and ocular melanoma. Adjuvant RT following lymphadenectomy in node-positive melanoma patients prevents local and regional recurrence; however, the role of adjuvant RT remains controversial and underutilized due to lack of overall survival benefit. On the other hand, RT is highly effective in providing symptom palliation for metastatic melanoma and is widely used. Advanced RT technologies such as stereotactic radiosurgery (SRS) and stereotactic body radiotherapy (SBRT) can achieve excellent local control with minimum toxicities. They are commonly used in the management of brain, lung, spine, and liver metastases. Most recently, it is under active investigation on combining RT with new systemic options, such as targeted therapy, or immunotherapy. The advancements in the treatment of patients with melanoma highlight the importance of multidisciplinary management in this disease. Radiation therapy will continue to be one of the key therapeutic options.

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“…Approximately 13% of patients with melanoma present with brain metastases at diagnosis, and up to 40% of all patients with melanoma will develop brain metastases during the course of their illness ( 2 ). Progression of intracranial disease is a common cause of death once brain metastases are diagnosed, and historically, patients had a median survival of 6 months ( 3 ). Control of intracranial disease prolongs life and prevents neurologic morbidity.…”

Section: Introductionmentioning

confidence: 99%

Volume of Disease as a Predictor for Clinical Outcomes in Patients With Melanoma Brain Metastases Treated With Stereotactic Radiosurgery and Immune Checkpoint Therapy

et al. 2022

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Purpose/ObjectivesClinical trials of anti-Programmed cell death protein 1 (PD-1) and cytotoxic T-lymphocyte-associated protein (CTLA-4) therapies have demonstrated a clinical benefit with low rates of neurologic adverse events in patients with melanoma brain metastases (MBMs). While the combined effect of these immunotherapies (ITs) and stereotactic radiosurgery (SRS) has yielded impressive results with regard to local control (LC) and overall survival (OS), it has also been associated with increased rates of radiation necrosis (RN) compared to historical series of SRS alone. We retrospectively reviewed patients treated with IT in combination with SRS to report on predictors of clinical outcomes.Materials and MethodsPatients were included if they had MBMs treated with SRS within 1 year of receiving anti-PD-1 and/or CTLA-4 therapy. Clinical outcomes including OS, LC, intracranial death (ID), and RN were correlated with type and timing of IT with SRS, radiation dose, total volume, and size and number of lesions treated.ResultsTwenty-nine patients with 171 MBMs were treated between May 2012 and May 2018. Patients had a median of 5 lesions treated (median volume of 6.5 cm3) over a median of 2 courses of SRS. The median dose was 21 Gy. Most patients were treated with ipilimumab (n = 13) or nivolumab-ipilimumab (n = 10). Most patients underwent SRS concurrently or within 3 months of receiving immunotherapy (n = 21). Two-year OS and LC were 54.4% and 85.5%, respectively. In addition, 14% of patients developed RN; however, only 4.7% of the total treated lesions developed RN. The median time to development of RN was 9.5 months. Patients with an aggregate tumor volume >6.5 cm3 were found to be at increased risk of ID (p = 0.05) and RN (p = 0.03). There was no difference in OS, ID, or RN with regard to type of IT, timing of SRS and IT, number of SRS courses, SRS dose, or number of cumulative lesions treated.ConclusionsIn our series, patients treated with SRS and IT for MBMs had excellent rates of OS and LC; however, patients with an aggregate tumor volume >6.5 cm3 were found to be at increased risk of ID and RN. Given the efficacy of combined anti-PD-1/CTLA-4 therapy for MBM management, further study of optimal selection criteria for the addition of SRS is warranted.

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Stereotactic Radiosurgery for Melanoma Brain Metastases: A Comprehensive Clinical Case Series

Cited by 12 publications

References 25 publications

Validation of the Graded Prognostic Assessment for Melanoma Using Molecular Markers (Melanoma-molGPA)

Validation of the Graded Prognostic Assessment for Melanoma Using Molecular Markers (Melanoma-molGPA)

Radiation Therapy for Melanoma

Volume of Disease as a Predictor for Clinical Outcomes in Patients With Melanoma Brain Metastases Treated With Stereotactic Radiosurgery and Immune Checkpoint Therapy

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