Feng Rui, Oermann Eric K, Shrivastava Raj, Gold Ariel, Collins Brian T, Kondziolka Douglas, Collins Sean P
Department of Neurosurgery, Icahn School of Medicine at Mount Sinai, New York, New York, USA.
Department of Radiation Medicine, Georgetown University School of Medicine, Washington, D.C., USA.
World Neurosurg. 2017 Apr;100:297-304. doi: 10.1016/j.wneu.2017.01.014. Epub 2017 Jan 16.
Melanoma has high propensity to metastasize to the brain. With recent gains in improving patient survival, stereotactic radiosurgery (SRS) may offer an effective and less neurotoxic alternative to whole-brain radiation. In the study, we report on the safety and efficacy of SRS in treating melanoma brain metastases in 87 patients.
This retrospective multicenter study examined 87 patients with 309 metastases who underwent single-dose or multifractionated SRS for treatment of intracranial metastases from malignant melanoma.
A total of 87 patients with a median age of 62 years (26-85) were treated from 2007-2014. Eighty patients (92%) also had extracranial metastases at time of treatment, and 69 patients (79%) had uncontrolled systemic disease. Seventy-nine patients (91%) underwent single-dose fractions, 7 (8%) underwent 3 fractions, and 1 (1%) was treated in 5 fractions. The mean tumor volume (GTV) treated was 1.92 cc. Five patients developed symptoms of acute phase toxicity, and 4 developed late phase toxicity. None had radionecrosis. The median survival was 6 months. The Kaplan-Meier 1-year survival rate was 31%, and the 1-year local control rate was 91%. The 1-year survival rate for BRAF-positive patients was 42%, and for BRAF-negative patients it was 27%. Forty-two patients (48%) had distant intracranial recurrences, and 1-year distant control rate was 32%.
SRS is a safe and effective treatment option for intracranial metastases from malignant melanoma. This paper serves as a reference for what is achievable in the absence of highly effective systemic therapy.
黑色素瘤极易转移至脑部。随着近期患者生存率的提高，立体定向放射外科（SRS）可能为全脑放疗提供一种有效且神经毒性较小的替代方案。在本研究中，我们报告了SRS治疗87例黑色素瘤脑转移患者的安全性和有效性。
这项回顾性多中心研究检查了87例患有309处转移灶的患者，这些患者接受了单剂量或多分次SRS治疗恶性黑色素瘤的颅内转移灶。
2007年至2014年共治疗了87例患者，中位年龄为62岁（26 - 85岁）。80例患者（92%）在治疗时也有颅外转移，69例患者（79%）有未控制的全身疾病。79例患者（91%）接受了单剂量分割，7例（8%）接受了3次分割，1例（1%）接受了5次分割。治疗的平均肿瘤体积（GTV）为1.92立方厘米。5例患者出现急性期毒性症状，4例出现晚期毒性。无一例发生放射性坏死。中位生存期为6个月。Kaplan-Meier 1年生存率为31%，1年局部控制率为91%。BRAF阳性患者的1年生存率为42%，BRAF阴性患者为27%。42例患者（48%）发生远处颅内复发，1年远处控制率为32%。
SRS是治疗恶性黑色素瘤颅内转移的一种安全有效的治疗选择。本文为在缺乏高效全身治疗的情况下可实现的目标提供了参考。
