Distant Intracranial Failure in Melanoma Brain Metastases Treated with Stereotactic Radiosurgery in the Era of Immunotherapy and Targeted Agents

Overview

Journal Adv Radiat Oncol

Specialty Oncology

Date 2017 Dec 6

PMID 29204524

Citations 33

Authors

Sahaja Acharya

Mustafaa Mahmood

Daniel Mullen

Deshan Yang

Christina I Tsien

Jiayi Huang

Stephanie M Perkins

Keith Rich

Michael Chicoine

Eric Leuthardt

Joshua Dowling

Gavin Dunn

Jesse Keller

Clifford G Robinson

Christopher Abraham

Affiliations

Soon will be listed here.

Abstract

Purpose: Stereotactic radiosurgery (SRS) in combination with immunotherapy (IMT) or targeted therapy is increasingly being used in the setting of melanoma brain metastases (MBMs). The synergistic properties of combination therapy are not well understood. We compared the distant intracranial failure rates of intact MBMs treated with SRS, SRS + IMT, and SRS + targeted therapy.

Methods And Materials: Combination therapy was defined as delivery of SRS within 3 months of IMT (anti-CTLA-4 /anti-PD-1 therapy) or targeted therapy (BRAF/MEK inhibitors). The primary endpoint was distant intracranial failure after SRS, which was defined as any new MBM identified on brain magnetic resonance imaging. Outcomes were evaluated using the Kaplan Meier method and Cox proportional hazards.

Results: A total of 72 patients with melanoma with 233 MBMs were treated between April 2006 and April 2016. The number of MBMs within each treatment group was as follows: SRS: 121; SRS + IMT: 48; and SRS + targeted therapy: 64. The median follow-up was 8.9 months. One-year distant intracranial control rates for SRS, SRS + IMT, and SRS + targeted therapy were 11.5%, 60%, and 10%, respectively ( < .001). On multivariate analysis, after adjusting for steroid use and number of MBMs, SRS + IMT remained associated with a significant reduction in distant intracranial failure compared with SRS (hazard ratio [HR], 0.48; 95% confidence interval [CI], 0.29-0.80; = .003) and compared with SRS + targeted therapy (HR, 0.41; 95% CI, 0.25-0.68; = .001).One-year local control for SRS, SRS + IMT, and SRS + targeted therapy was 66%, 85%, and 72%, respectively ( = .044). On multivariate analysis, after adjusting for dose, SRS + IMT remained associated with a significant reduction in local failure compared with SRS alone (HR, 0.37; 95% CI, 0.14-0.95; = .04).

Conclusions: SRS with immunotherapy is associated with decreased distant and local intracranial failure compared with SRS alone. Prospective studies are warranted to validate this result.

Citing Articles

Distant brain failure after stereotactic radiosurgery for brain metastases in patients receiving novel systemic treatments.

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Radiotherapy in patients with brain metastases with and without concomitant immunotherapy: comparison of patient outcome and neurotoxicity.

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Vaios E, Shenker R, Hendrickson P, Wan Z, Niedzwiecki D, Winter S Int J Radiat Oncol Biol Phys. 2023; 118(5):1507-1518.

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