(P132) Stereotactic Radiosurgery to Five or More Brain Metastases in Melanoma Patients

OncologyOncology Vol 28 No 1S
Volume 28
Issue 1S

Linear accelerator–based stereotactic radiosurgery (SRS) is a treatment option for melanoma patients who have developed brain metastases. Few data are available on treatment of patients with ≥ 5 lesions. We sought to determine the effectiveness of SRS in patients with ≥ 5 melanoma brain metastases.

Jessica Freilich, MD, Nicholas Figura, BS, Kamran Ahmed, MD, Neha Patel, BS, Christian Thomas, BS, Siriporn Sarangkasiri, MS, Prakash Chinnaiyan, MD, Nikhil Rao, MD, Arnold Etame, MD, PhD; Moffitt Cancer Center

Purpose and Objectives: Linear accelerator–based stereotactic radiosurgery (SRS) is a treatment option for melanoma patients who have developed brain metastases. Few data are available on treatment of patients with ≥ 5 lesions. We sought to determine the effectiveness of SRS in patients with ≥ 5 melanoma brain metastases.

Materials and Methods: An analysis of patients with metastatic melanoma treated with SRS to ≥ 5 lesions in one treatment session was performed. Magnetic resonance imaging (MRI) scans were reviewed post-SRS to evaluate local control (LC). Disease progression by imaging was defined by the 2009 Response Evaluation Criteria in Solid Tumors (RECIST) criteria. Survival curves were calculated according to the Kaplan-Meier (KM) method from the date of brain metastases diagnosis or date of SRS. Univariate (UVA) and multivariate analysis (MVA) was performed by the Cox proportional hazards model.

Results: We identified 149 metastatic brain lesions treated in 28 patients. The median age of patients was 60.5 (range: 38–83 yr), and the majority (n = 24, 85.7%) had extracranial metastases. Four patients (14.3%) received previous whole-brain radiation therapy (WBRT), and 11 patients (39.3%) received previous SRS. The median planning target volume (PTV) was 0.34 cm3 (range: 0.01–12.5 cm3). Median follow-up was 6.3 months (range: 1–46 mo). At the time of treatment, 7% of patients were recursive partitioning analysis (RPA) class I, 89% was RPA class II, and 4% was RPA class III. The rate of local failure was 11.4%. KM local control estimates at 6 and 12 months were 91.3% and 82.2%, respectively. PTV volume ≥ 0.34 cm3 was a significant predictor of local failure on UVA (hazard ratio [HR] = 16.1; 95% confidence interval [CI], 3.2–292.6; P < .001) and MVA (HR = 14.8; 95% CI, 3.0–268.5; P < .001). Sixteen (57.4%) patients were noted to undergo distant failure in the brain, with a median time to failure of 3 months (range: 1–15 mo). Nine patients with distant brain failures received WBRT, and seven patients received additional SRS. Median overall survival (OS) was 9.4 and 7.6 months from the date of brain metastases diagnosis and date of SRS, respectively. The KM OS estimates at 6 and 12 months were 57.8% and 28.2%, respectively, from the time of SRS treatment. RPA class was a significant predictor of KM OS estimates from date of treatment (P = .02). Patients who did not receive WBRT after SRS treatment had decreased OS on MVA (HR = 3.5; 95% CI, 1.1–12.0; P = .03), and patients who did not receive WBRT prior to SRS had improved OS (HR = 0.11; 95% CI, 0.02–0.53; P = .007).

Conclusions: SRS to ≥ 5 lesions appears to be effective for selected patients with metastatic melanoma, offering excellent local control. This is particularly important for patients, as new targeted systemic agents are improving outcomes but still have limited efficacy within the central nervous system.

Articles in this issue

(P113) Age and Marital Status Are Associated With Choice of Mastectomy in Patients Eligible for Breast Conservation Therapy
(P112) Single-Institution Experience With Intrabeam IORT for Treatment of Early-Stage Breast Cancer
(P110) Breast Cancer Before Age 40: Current Patterns in Clinical Presentation and Local Management
(P111) Accelerated Partial-Breast Irradiation With Multicatheter High-Dose-Rate Brachytherapy: Feasibility and Results in a Private Practice Cohort
(P115) Breast Cancer Laterality Does Not Influence Overall Survival in a Large Modern Cohort: Implications for Radiation-Related Cardiac Mortality
(P117) Anatomical Variations and Radiation Technique for Breast Cancer
(P116) Bilateral Immediate DIEP Reconstruction and Postmastectomy Radiotherapy: Experience at a Tertiary Care Institution
(P118) Metadherin Overexpression Is Associated With Improved Locoregional Control After Mastectomy
(P119) Effect of Economic Environment on Use of Postlumpectomy Radiation Therapy for Stage I Breast Cancer
(P120) Immediate Versus Delayed Reconstruction After Mastectomy in the United States Medicare Breast Cancer Patient
(P121) Trend in Age and Racial Disparities in the Receipt of Postlumpectomy Radiation Therapy for Stage I Breast Cancer: 2004–2009
(P122) Streamlining Referring Physicians Orders With ‘Reflex Testing’ Significantly Decreases Time to Resolution for Abnormal Screening Mammograms
(P123) National Trends in the Local Management of Early-Stage Paget Disease of the Breast
(P124) Effect of Inhomogeneity on Cardiac and Lung Dose in Partial-Breast Irradiation Using HDR Brachytherapy
(P125) Breast Cancer Outcomes With Anthracycline-Based Chemotherapy for Residual Disease Burden After Full-Dose Neoadjuvant Chemotherapy and Surgery Followed by Radiation Treatment
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