Department of Radiation Oncology, University of Virginia, Charlottesville, VA, USA.
Department of Radiation Oncology, Mayo Clinic, 4500 San Pablo Road South, Jacksonville, FL, 32224, USA.
J Neurooncol. 2018 Oct;140(1):83-88. doi: 10.1007/s11060-018-2933-2. Epub 2018 Jun 20.
Stereotactic radiosurgery (SRS) is a common treatment modality among patients with brain metastases, particularly from malignant melanoma. Our objective was to investigate the difference in local control, toxicity, and survival among patients with hemorrhagic and solid melanoma brain metastases.
We collected demographic, treatment, local control, toxicity, and survival for 134 patients with a total of 936 intracranial melanoma metastases who underwent SRS between 1998 and 2015. Pre-radiosurgical diagnostic imaging was reviewed for evidence of hemorrhage (melanin-containing or clearly hemorrhagic).
The cohort consisted of 92 men and 42 women with a mea age of 61.7 years (range 21.2-84.9) at the time of radiosurgery. Overall survival of patients with brain metastases from malignant melanoma was 42, 31, 12% at 12, 24, and 72 months from date of first SRS. At 6 months, 43% of the patients with hemorrhagic metastases had local tumor control compared to 83% of solid melanoma metastases (p < 0.001). No significant difference in toxicity was noted between the two groups. Factors that were significantly associated with time to local tumor progression on multivariate analysis include prior WBRT (HR 1.62, p = 0.003), prior chemotherapy (HR 0.69, p = 0.011), margin dose (HR 0.88, p < 0.001) and radiographic features of melanin deposition (HR 3.73, p < 0.001), or clear hemorrhage (HR 2.20, p < 0.001).
Our findings demonstrate that hemorrhagic intracranial melanoma metastases are associated with inferior local tumor control when treated with SRS, as compared to solid tumors. These results highlight the importance of early radiosurgery among patients with melanoma brain metastases before hemorrhage occurs.
立体定向放射外科（SRS）是脑转移瘤患者的常见治疗方式，尤其是来源于恶性黑色素瘤的患者。我们的目的是研究出血性和实体性黑色素瘤脑转移瘤患者之间的局部控制、毒性和生存的差异。
我们收集了 1998 年至 2015 年间共 134 例接受 SRS 治疗的脑转移瘤患者的人口统计学、治疗、局部控制、毒性和生存数据，共 936 个颅内黑色素瘤转移灶。回顾术前放射影像学检查，明确有无出血（含黑色素或明确出血）。
本队列包括 92 名男性和 42 名女性患者，放射外科治疗时的平均年龄为 61.7 岁（范围 21.2-84.9）。从首次 SRS 治疗开始，恶性黑色素瘤脑转移患者的总体生存率为 12、24 和 72 个月时的 42%、31%和 12%。在 6 个月时，出血性脑转移瘤患者的局部肿瘤控制率为 43%，而实体黑色素瘤转移瘤患者的局部肿瘤控制率为 83%（p<0.001）。两组间毒性无显著差异。多因素分析显示，局部肿瘤进展时间的相关因素包括：全脑放疗（HR 1.62，p=0.003）、化疗（HR 0.69，p=0.011）、边缘剂量（HR 0.88，p<0.001）和黑色素沉积的影像学特征（HR 3.73，p<0.001）或明确出血（HR 2.20，p<0.001）。
我们的研究结果表明，与实体瘤相比，SRS 治疗的出血性颅内黑色素瘤转移瘤局部肿瘤控制效果较差。这些结果强调了在出血发生之前，对黑色素瘤脑转移患者进行早期放射外科治疗的重要性。
