The British journal of radiology · 2026
Efficacy and safety of stereotactic radiosurgery in the management of brain metastases in patients with metastatic melanoma.
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McMahon David J, Aboulela Mohamed, De Boisanger James, Soto-Castillo Juan Jose, Beland Chloe, Cheruvu Sowmya, Brewer Martin, Idaikkadar Praveena, Furness Andrew, Turajlic Samra, Young Kate, Pickering Lisa, Welsh Liam, Rosenfelder Nicola, Larkin James, Solda Francesca
Аннотация
OBJECTIVES: We sought to identify factors associated with prognosis and bleeding in patients with melanoma brain metastases (BM). Objectives were median overall survival (mOS [months]) and bleeding incidence.
METHODS: We conducted a retrospective analysis of patients receiving stereotactic radiosurgery (SRS) at our centre 11/15-11/23. Analysis was performed on Prism 10.1.1. Extraction from electronic medical records was undertaken by authors, with local R&D approval (NEU012).
RESULTS: A total of 81 patients were evaluable. One hundred and nineteen treatment courses were delivered. There were no bleeding events (BEs) in the first 7 days, 1 within 28 days (0.8%) and 19 within 90 days (16%). Overall, 7.6% (N = 9) died within 90 days, and 25.2% (N = 30) died within 6 m. There were no deaths within 30 days or related to treatment. mOS was 17.6 m (95% confidence interval [CI] 9.20-35.05). Significantly inferior survival outcomes were observed for patients with elevated lactate dehydrogenase (LDH), poor performance status (Karnofsky performance status [KPS]), higher total treated intracranial volume (gross target volume [GTV]), and total number of BM. mOS of patients with a normal LDH was 37.0 m vs 5.2 m for those with LDH > upper limit of normal (ULN) (HR 4.40, P<.0001). This was also true on multivariable analysis including KPS, BM number, and BM size (HR 3.75 95% CI, 1.94-7.30, P ≤.0001). For patients with KPS ≥90, mOS was 35.0 m vs 7.7 m for KPS ≤80 (HR 2.55, P<.0004). This was significant using the multivariable analysis described above (HR 2.12 95% CI, 1.123-3.948, P = .0181).
CONCLUSIONS: Despite theoretically high risk of bleeding after SRS in MM BM, incidence of bleeding in our cohort was low. mOS was comparable to historical controls of 16-23 months.
ADVANCES IN KNOWLEDGE: We novelly performed univariate and multivariate analysis demonstrating poor survival outcomes in patients with high LDH, poor performance status, and larger BM (both by BM size and number).
METHODS: We conducted a retrospective analysis of patients receiving stereotactic radiosurgery (SRS) at our centre 11/15-11/23. Analysis was performed on Prism 10.1.1. Extraction from electronic medical records was undertaken by authors, with local R&D approval (NEU012).
RESULTS: A total of 81 patients were evaluable. One hundred and nineteen treatment courses were delivered. There were no bleeding events (BEs) in the first 7 days, 1 within 28 days (0.8%) and 19 within 90 days (16%). Overall, 7.6% (N = 9) died within 90 days, and 25.2% (N = 30) died within 6 m. There were no deaths within 30 days or related to treatment. mOS was 17.6 m (95% confidence interval [CI] 9.20-35.05). Significantly inferior survival outcomes were observed for patients with elevated lactate dehydrogenase (LDH), poor performance status (Karnofsky performance status [KPS]), higher total treated intracranial volume (gross target volume [GTV]), and total number of BM. mOS of patients with a normal LDH was 37.0 m vs 5.2 m for those with LDH > upper limit of normal (ULN) (HR 4.40, P<.0001). This was also true on multivariable analysis including KPS, BM number, and BM size (HR 3.75 95% CI, 1.94-7.30, P ≤.0001). For patients with KPS ≥90, mOS was 35.0 m vs 7.7 m for KPS ≤80 (HR 2.55, P<.0004). This was significant using the multivariable analysis described above (HR 2.12 95% CI, 1.123-3.948, P = .0181).
CONCLUSIONS: Despite theoretically high risk of bleeding after SRS in MM BM, incidence of bleeding in our cohort was low. mOS was comparable to historical controls of 16-23 months.
ADVANCES IN KNOWLEDGE: We novelly performed univariate and multivariate analysis demonstrating poor survival outcomes in patients with high LDH, poor performance status, and larger BM (both by BM size and number).