(P011) Stereotactic Radiosurgery and BRAF Inhibitor Therapy for Melanoma Brain Metastases Is Associated With Increased Risk for Radiation Necrosis

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OncologyOncology Vol 29 No 4_Suppl_1
Volume 29
Issue 4_Suppl_1

Rates of symptomatic radiation necrosis appear to be higher for the BRAF inhibitor therapy group. Prospective studies investigating BRAF inhibitor therapy and SRS for melanoma brain metastases should consider incorporating methods to decrease potential radiation necrosis, including fractionating radiosurgery.

Kirtesh Patel, MD, Roshan Prabhu, MD, Mohammad K. Khan, MD; Winship Cancer Institute, Emory University; Levine Cancer Institute, Carolinas Medical Center

INTRODUCTION: Melanoma is an aggressive malignancy with a deplorable penchant for spreading to the brain. BRAF inhibitors, as single agents, have demonstrated intracranial efficacy. The 2015 National Comprehensive Cancer Network (NCCN) guidelines have raised concerns about increased toxicity when BRAF inhibitors are combined with radiotherapy, based on limited case reports. Thus, we investigate the safety and efficacy of stereotactic radiosurgery (SRS) and BRAF inhibitors for melanoma brain metastases patients.

METHODS: We reviewed melanoma patients with newly diagnosed brain metastases from 2005–2012. Radiation necrosis was compared by Fisher’s exact test; local control, intracranial control, and overall survival were estimated by the Kaplan-Meier method.

RESULTS: A total of 72 patients received SRS, with 12 (16.7%) also receiving BRAF inhibitor therapy. BRAF inhibitor patients were similar to SRS-alone patients, except for having a higher percentage of RPA class 3 patients (25.0% vs 0.0%; P = .0030) and lower rates of solitary metastases (25.0% vs 55.0%; P = .034). No significant differences between radiation therapy total dose and dose per fraction, gross tumor volume (GTV), prescription isodose line, or conformality index were identified. Rates of all grades of radiation necrosis were statistically higher in the BRAF cohorts (58.3 vs 26.7%; P = .044); furthermore, symptomatic radiation necrosis was also more frequent in the BRAF inhibitor group (41.7% vs 15.0%; P = .048). One-year local control (83.5% vs 83.5%, P = .835) and intracranial control were similar between cohorts (30.3% vs 26.3%; P = .395). One-year overall survival was higher in the BRAF inhibitor group but not statistically significant (72.7% vs 38.1%; P = .172).

CONCLUSION: Rates of symptomatic radiation necrosis appear to be higher for the BRAF inhibitor therapy group. Prospective studies investigating BRAF inhibitor therapy and SRS for melanoma brain metastases should consider incorporating methods to decrease potential radiation necrosis, including fractionating radiosurgery.

Proceedings of the 97th Annual Meeting of the American Radium Society - americanradiumsociety.org

Articles in this issue

(P005) Ultrasensitive PSA Identifies Patients With Organ-Confined Prostate Cancer Requiring Postop Radiotherapy
(P001) Disparities in the Local Management of Breast Cancer in the United States According to Health Insurance Status
(P002) Predictors of CNS Disease in Metastatic Melanoma: Desmoplastic Subtype Associated With Higher Risk
(P003) Identification of Somatic Mutations Using Fine Needle Aspiration: Correlation With Clinical Outcomes in Patients With Locally Advanced Pancreatic Cancer
(P004) A Retrospective Study to Assess Disparities in the Utilization of Intensity-Modulated Radiotherapy (IMRT) and Proton Therapy (PT) in the Treatment of Prostate Cancer (PCa)
(S001) Tumor Control and Toxicity Outcomes for Head and Neck Cancer Patients Re-Treated With Intensity-Modulated Radiation Therapy (IMRT)-A Fifteen-Year Experience
(S003) Weekly IGRT Volumetric Response Analysis as a Predictive Tool for Locoregional Control in Head and Neck Cancer Radiotherapy 
(S004) Combination of Radiotherapy and Cetuximab for Aggressive, High-Risk Cutaneous Squamous Cell Cancer of the Head and Neck: A Propensity Score Analysis
(S005) Radiotherapy for Carcinoma of the Hypopharynx Over Five Decades: Experience at a Single Institution
(S002) Prognostic Value of Intraradiation Treatment FDG-PET Parameters in Locally Advanced Oropharyngeal Cancer
(P006) The Role of Sequential Imaging in Cervical Cancer Management
(P008) Pretreatment FDG Uptake of Nontarget Lung Tissue Correlates With Symptomatic Pneumonitis Following Stereotactic Ablative Radiotherapy (SABR)
(P009) Monte Carlo Dosimetry Evaluation of Lung Stereotactic Body Radiosurgery
(P010) Stereotactic Body Radiotherapy for Treatment of Adrenal Gland Metastasis: Toxicity, Outcomes, and Patterns of Failure
(P011) Stereotactic Radiosurgery and BRAF Inhibitor Therapy for Melanoma Brain Metastases Is Associated With Increased Risk for Radiation Necrosis
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