Stereotactic radiosurgery for melanoma brain metastases: Concurrent immune checkpoint inhibitor therapy associated with superior clinicoradiological response outcomes
Introduction/purpose This study assessed long‐term clinical and radiological outcomes following treatment with combination stereotactic radiosurgery (SRS) and immunotherapy (IT) for melanoma brain metastases (BM). Methods A retrospective review was performed in a contemporary cohort of patients with...
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| Published in: | Journal of medical imaging and radiation oncology Vol. 66; no. 4; pp. 536 - 545 |
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| Main Authors: | , , , , , , , , , , , , , |
| Format: | Journal Article |
| Language: | English |
| Published: |
Australia
Wiley Subscription Services, Inc
01-06-2022
John Wiley and Sons Inc |
| Subjects: | |
| Online Access: | Get full text |
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| Summary: | Introduction/purpose
This study assessed long‐term clinical and radiological outcomes following treatment with combination stereotactic radiosurgery (SRS) and immunotherapy (IT) for melanoma brain metastases (BM).
Methods
A retrospective review was performed in a contemporary cohort of patients with melanoma BM at a single tertiary institution receiving Gamma Knife® SRS for melanoma BM. Multivariate Cox proportional‐hazards modelling was performed with a P <0.05 for significance.
Results
101 patients (435 melanoma BM) were treated with SRS between January‐2015 and June‐2019. 68.3% of patients received IT within 4 weeks of SRS (concurrent) and 31.7% received SRS alone or non‐concurrently with IT. Overall, BM local control rate was 87.1% after SRS. Median progression free survival was 8.7 months. Median follow‐up was 29.2 months. On multivariate analysis (MVA), patients receiving concurrent SRS‐IT maintained a higher chance of achieving a complete (CR) or partial response (PR) [HR 2.6 (95% CI: 1.2–5.5, P = 0.012)] and a reduced likelihood of progression of disease (PD) [HR 0.52 (95% CI: 0.16–0.60), P = 0.048]. Any increase in BM volume on the initial MRI 3 months after SRS predicted a lower likelihood of achieving long‐term CR or PR on MVA accounting for concurrent IT, BRAF status and dexamethasone use [HR = 0.048 (95% CI: 0.007–0.345, P = 0.0026)]. Stratified volumetric change demonstrated a sequential relationship with outcomes on Kaplan–Meier analysis.
Conclusion
Concurrent SRS‐IT has favourable clinical and radiological outcomes with respect to CR, PR and a reduced likelihood of PD. Changes in BM volume on the initial MRI 3 months after SRS were predictive of long‐term outcomes for treatment response. |
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| Bibliography: | S Garimall MBBS M Huo MBBS, FRACP E Le Cornu MBBS, FRANZCR MC Foote K Muscat W Xu S Crowley N Gatt T Watkins MB Pinkham V Atkinson FRANZCR, MBBS, MPhil MMed, BEng (Biomedical)(Hons) H Foley BMedRadSc (Radiation Therapy) BMBCh, FRANZCR. Conflict of interest: This article received support in the form of research grants from the PA Research Foundation. The article did not have any support in the form of equipment and/or pharmaceutical items. W Soon MD Shanker BAppSc (MRT) ObjectType-Article-1 SourceType-Scholarly Journals-1 ObjectType-Feature-2 content type line 23 MD Shanker FRANZCR, MBBS, MPhil MMed, BEng (Biomedical)(Hons); S Garimall MBBS; N Gatt MBBS; H Foley BAppSc (MRT); S Crowley BAppSc (MRT); E Le Cornu BMedRadSc (Radiation Therapy); K Muscat BAppSc (MRT); W Soon MBBS; V Atkinson MBBS, FRACP; W Xu MBBS, FRACP; T Watkins MBBS, FRANZCR; M Huo MBBS, FRANZCR, MC Foote MBBS, FRANZCR, MB Pinkham BMBCh, FRANZCR. |
| ISSN: | 1754-9477 1754-9485 |
| DOI: | 10.1111/1754-9485.13403 |