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01-12-2020 | Metastasis | Research

Stereotactic radiosurgery combined with targeted/ immunotherapy in patients with melanoma brain metastasis

Authors: Indrawati Hadi, Olarn Roengvoraphoj, Raphael Bodensohn, Jan Hofmaier, Maximilian Niyazi, Claus Belka, Silke Birgit Nachbichler

Published in: Radiation Oncology | Issue 1/2020

Abstract

Background

There is limited data on the use of targeted or immunotherapy (TT/IT) in combination with single fraction stereotactic radiosurgery (SRS) in patients with melanoma brain metastasis (MBM). Therefore, we analyzed the outcome and toxicity of SRS alone compared to SRS in combination with TT/IT.

Methods

Patients with MBM treated with single session SRS at our department between 2014 and 2017 with a minimum follow-up of 3 months after first SRS were included. The primary endpoint of this study was local control (LC). Secondary endpoints were distant intracranial control, radiation necrosis-free survival (RNFS), and overall survival (OS). The local/ distant intracranial control rates, RNFS and OS were analyzed using the Kaplan-Meier method. The log-rank test was used to test differences between groups. Cox proportional hazard model was performed for univariate continuous variables and multivariate analyses.

Results

Twenty-eight patients (17 male and 11 female) with 52 SRS-lesions were included. The median follow-up was 19 months (range 14–24 months) after first SRS. Thirty-six lesions (69.2%) were treated with TT/IT simultaneously (4 weeks before and 4 weeks after SRS), while 16 lesions (30.8%) were treated with SRS alone or with sequential TT/IT. The 1-year local control rate was 100 and 83.3% for SRS with TT/IT and SRS alone (p = 0.023), respectively. The estimated 1-year RNFS was 90.0 and 82.1% for SRS in combination with TT/IT and SRS alone (p = 0.935). The distant intracranial control rate after 1 year was 47.7 and 50% for SRS in combination with TT/IT and SRS alone (p = 0.933). On univariate analysis, the diagnosis-specific Graded Prognostic Assessment including the BRAF status (Melanoma-molGPA) was associated with a significantly improved LC. Neither gender nor SRS-PTV margin had a prognostic impact on LC. V10 and V12 were significantly associated with RNFS (p < 0.001 and p = 0.004).

Conclusion

SRS with simultaneous TT/IT significantly improved LC with no significant difference in radiation necrosis rate. The therapy combination appears to be effective and safe. However, prospective studies on SRS with simultaneous TT/IT are necessary and ongoing.

Trial registration

The institutional review board approved this analysis on 10th of February 2015 and all patients signed informed consent (UE nr. 128–14).

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Title: Stereotactic radiosurgery combined with targeted/ immunotherapy in patients with melanoma brain metastasis
Authors: Indrawati Hadi
Olarn Roengvoraphoj
Raphael Bodensohn
Jan Hofmaier
Maximilian Niyazi
Claus Belka
Silke Birgit Nachbichler
Publication date: 01-12-2020
Publisher: BioMed Central
Keywords: Metastasis
Melanoma
Melanoma
Published in: Radiation Oncology / Issue 1/2020
Electronic ISSN: 1748-717X
DOI: https://doi.org/10.1186/s13014-020-1485-8

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Stereotactic radiosurgery combined with targeted/ immunotherapy in patients with melanoma brain metastasis

Abstract

Background

Methods

Results

Conclusion

Trial registration

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Background

Methods

Results

Conclusion

Trial registration

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