Department of Clinical Radiation Oncology, Ernst von Bergman Medical Center, Academic Teaching Hospital of Charité - Universitätsmedizin Berlin, 14467, Potsdam, Germany.
Department of Radiation Oncology, Charité - Universitätsmedizin Berlin, Campus Virchow-Klinikum, Augustenburger Platz 1, 13353, Berlin, Germany.
Radiat Oncol. 2018 Jan 10;13(1):3. doi: 10.1186/s13014-017-0951-4.
Malignant melanoma brain metastases (MBM) are the third most common cause for brain metastases (BM). Historically Whole-brain radiotherapy (WBRT) was considered the goldstandard of treatment even though melanoma cells are regarded as very radioresistant. Therapeutic possibilities have fundamentally changed since the availability of stereotactic radiotherapy (SRT), where it is possible to apply high ablative doses in a very precise manner. In this work we analyze prognostic factors of overall survival (OS) after SRT in patients with MBM and evaluate the applicability of popular prognostic indices that mainly stem from the WBRT-era.
This work is a retrospective analysis of OS of 80 malignant melanoma (MM) patients who received SRT for intracranial melanoma metastases between 2004 and 2014 who had not received prior treatment for MBM in terms of surgery or WBRT. Potential prognostic factors were analyzed using univariable and multivariable analysis. Existing prognostic scores [Graded Prognostic Assessment (GPA), Diagnosis-Specific-GPA (DS-GPA), Golden Grading System (GGS) and RADES] were calculated and tested using log-rank analysis.
Eighty patients, respectively 177 brain metastases, were irradiated. The median survival time from radiation was 7.06 months. Overall, GGS, GPA and DS-GPA were significant predictors of survival. The MM-specific index DS-GPA showed the best p-value but did not show adequate division when looking at the two intermediate risk subgroups. RADES did not show any statistically significant prognostic value. In univariable as well as in multivariable analyses a higher Karnofsky-Index, a single BM, and non nodular melanoma (NM) histology were positive predictors of survival.
The existing prognostic scores do not seem to ideally fit for this special group of patients. Our results indicate that the histologic subtype of MM could add to the prognostic value of specialized future indices.
恶性黑色素瘤脑转移（MBM）是脑转移（BM）的第三大常见原因。历史上，全脑放疗（WBRT）被认为是治疗的金标准，尽管黑色素瘤细胞被认为具有很强的放射抗性。自从立体定向放疗（SRT）可用以来，治疗可能性发生了根本性的变化，因为可以非常精确地应用高消融剂量。在这项工作中，我们分析了 SRT 治疗 MBM 患者的总生存（OS）的预后因素，并评估了主要源自 WBRT 时代的流行预后指标的适用性。
这是一项回顾性分析，分析了 2004 年至 2014 年间接受 SRT 治疗颅内黑色素瘤转移的 80 名恶性黑色素瘤（MM）患者的 OS，这些患者之前未接受过手术或 WBRT 治疗 MBM。使用单变量和多变量分析分析潜在的预后因素。使用对数秩分析计算和测试现有的预后评分[分级预后评估（GPA）、诊断特异性-GPA（DS-GPA）、黄金分级系统（GGS）和 RADES]。
80 名患者，分别为 177 个脑转移灶，接受了放疗。从放疗开始的中位生存时间为 7.06 个月。总体而言，GGS、GPA 和 DS-GPA 是生存的显著预测因子。专门针对 MM 的指标 DS-GPA 显示出最佳的 p 值，但在观察两个中间风险亚组时，并未显示出足够的划分。RADES 没有显示出任何统计学上显著的预后价值。在单变量和多变量分析中，较高的 Karnofsky 指数、单个 BM 和非结节性黑色素瘤（NM）组织学是生存的正预测因子。
现有的预后评分似乎并不完全适合这组特殊患者。我们的结果表明，MM 的组织学亚型可以为未来专门的预后指数增加预后价值。
