Patients' Outcomes following Stereotactic Radiosurgery for Melanoma Brain Metastases
Abstract
Introduction: The treatment of melanoma brain metastases relies principally on surgery, stereotactic radiosurgery (SRS), and whole-brain radiotherapy (WBRT). Over the last five years, in addition to SRS, increasing numbers of patients have also received immunotherapy treatment for extracranial disease. This study set out to evaluate whether systemic immunotherapy or other treatment factors outlined herein impact survival.
Methods: A retrospective chart review was performed on all melanoma brain metastases patients treated with stereotactic radiosurgery at the University of Florida Cancer Center at Orlando Health from November 2008 to January 2014. A total of 55 patients were included.
Results: The median follow-up and overall survival for the 55 patients reviewed was 3.16 and 4.2 months, respectively. The number of metastases treated ranged from 1 to 10 (median 3). The treatment parameters of WBRT, surgery, and ipilimumab treatment for effect on survival were evaluated within this population. 43.63%, 20%, and 40% of patients received WBRT, surgery, and ipilimumab, respectively. Patients who did not undergo surgery had a hazard ratio of 3.483 (95% CI, 1.44-8.44; P < 0.01); patients who did not receive ipilimumab had a hazard ratio of 2.026 (95% CI, 1.056-3.885; P < 0.04) and patients who did not undergo WBRT had a hazard ratio of 0.543 (95% CI, 0.281-1.049; P = 0.0690].
Conclusion: Patients with melanoma brain metastases who undergo surgery (P < 0.01) or immunotherapy (ipilimumab, P < 0.04) in addition to the standard SRS treatment have improved survival rates. Further studies are needed to continue gaining a strong understanding of this potentially powerful treatment.
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