Ghia Amol J, Tward Jonathan D, Anker Christopher J, Boucher Kenneth M, Jensen Randy L, Shrieve Dennis C
Department of Radiation Oncology, 1950 Circle of Hope, Huntsman Cancer Institute, University of Utah, Salt Lake City, UT 84112.
Department of Radiation Oncology, MD Anderson Cancer Center, Houston, TX.
J Radiosurg SBRT. 2014;3(1):43-50.
To investigate the influence of stereotactic radiosurgery on the risk of hemorrhage from brain metastases from malignant melanoma.
A cohort of 110 patients treated with stereotactic radiosurgery (SRS) for 358 melanoma brain metastases was identified. The incidence of hemorrhage before and after SRS was determined by review of serial MRI scans. Statistical analysis was performed to determine the influence of SRS on rate of hemorrhage. Overall survival (OS) and local control (LC) were assessed and prognostic factors, including hemorrhage pre- or post-SRS were analyzed.
At presentation 83 of 358 (23.2%) melanoma metastases had hemorrhaged in 44 patients. Following SRS, 73 hemorrhages occurred in 358 treated tumors (20.4%). These rates were not significantly different; p=0.362, HR=0.846 (95% CI 0.591-1.211). The risk of post-SRS hemorrhage in patients was statistically significantly linked to previous hemorrhage. Fourteen of 65 patients (21.5%) who presented without hemorrhage prior to SRS subsequently demonstrated hemorrhage. Twenty-four of 44 patients (54.5%) who presented with hemorrhage went on to demonstrate further hemorrhage following SRS; p=0.005, HR 2.47 (95% CI 1.24-11.3). Mixed effects logistic regression modeling showed no influence of SRS on the risk of hemorrhage of a given lesion (p=0.99).OS at 1 year was better for patients presenting with a single metastasis (41.2%) compared to multiple metastases (20.3%, p=0.009). LC was 60.4% at 1 year following SRS. LC was significantly lower for metastases demonstrating hemorrhage either pre-SRS (51.7% vs 64.9%, p=0.03) or post-SRS (32.7% vs. 67.8%, p<0.001).
The current data show that SRS does not alter the risk of subsequent hemorrhage of treated metastases. However, hemorrhage may complicate follow-up assessment of response and LC following SRS. Careful assessment of imaging following SRS should include awareness that hemorrhage may mimic treatment failure in these patients.
探讨立体定向放射外科手术对恶性黑色素瘤脑转移瘤出血风险的影响。
确定一组110例接受立体定向放射外科手术（SRS）治疗358个黑色素瘤脑转移瘤的患者。通过回顾系列MRI扫描确定SRS前后出血的发生率。进行统计分析以确定SRS对出血率的影响。评估总生存期（OS）和局部控制率（LC），并分析包括SRS前后出血在内的预后因素。
在初次就诊时，358个（23.2%）黑色素瘤转移瘤中有83个在44例患者中发生了出血。SRS后，358个接受治疗的肿瘤中有73个发生了出血（20.4%）。这些发生率无显著差异；p = 0.362，HR = 0.846（95% CI 0.
