Matsunaga Shigeo, Shuto Takashi, Yamamoto Masaaki, Yomo Shoji, Kondoh Takeshi, Kobayashi Tatsuya, Sato Manabu, Okamoto Hisayo, Serizawa Toru, Nagano Osamu, Kenai Hiroyuki, Obara Takuma, Iwai Yoshiyasu, Yasuda Soichiro, Hasegawa Toshinori, Kubo Kenji, Shidoh Satoka, Mori Katsuharu, Hayashi Motohiro, Inoue Akira, Onoue Shinji, Gondo Masazumi
Department of Neurosurgery, Yokohama Rosai Hospital, Yokohama, Japan.
Stereotactic Radiotherapy Center, Yokohama Rosai Hospital, Yokohama, Japan.
Stereotact Funct Neurosurg. 2018;96(3):162-171. doi: 10.1159/000489948. Epub 2018 Jul 3.
The incidences of metastatic brain tumors from malignant melanomas have increased and survival has been prolonged by novel molecular targeted agents and immunotherapy. However, malignant melanomas are uncommon in Asian populations.
We retrospectively analyzed treatment efficacy and identified prognostic factors impacting tumor control and survival in Japanese melanoma patients with brain metastases treated with gamma knife radiosurgery (GKRS).
We retrospectively reviewed the medical records of 177 patients with 1,500 tumors who underwent GKRS for brain metastases from malignant melanomas. This study was conducted by the Japanese Leksell Gamma Knife Society (JLGK1501).
Six and 12 months after GKRS, the cumulative incidences of local tumor recurrence were 9.2 and 13.8%. Intratumoral hemorrhage (p < 0.0001) and larger tumor volume (p = 0.001) in GKRS were associated with significantly poorer local control outcomes. The use of immune checkpoint inhibitors before GKRS was significantly associated with symptomatic adverse events (p = 0.037). The median overall survival time after the initial GKRS was 7.3 months. Lower Karnofsky performance status scores (p = 0.016), uncontrolled primary cancer (p < 0.0001), and multiple brain metastases (p = 0.014) significantly influenced unfavorable overall survival outcomes. The cumulative incidences of neurological death 6 and 12 months after GKRS were 9.7 and 17.4%, those of neurological deterioration were 14.2 and 19.6%, and those of new tumor appearance were 34.5 and 40.5%.
The results of the present multicenter study suggest that GKRS is a relatively effective and safe modality for control of tumor progression in Japanese patients with brain metastases from malignant melanomas.
恶性黑色素瘤脑转移的发生率有所上升，新型分子靶向药物和免疫疗法延长了患者的生存期。然而，恶性黑色素瘤在亚洲人群中并不常见。
我们回顾性分析了日本黑色素瘤脑转移患者接受伽玛刀放射外科治疗（GKRS）的疗效，并确定影响肿瘤控制和生存的预后因素。
我们回顾性分析了177例患者共1500个肿瘤的病历，这些患者因恶性黑色素瘤脑转移接受了GKRS治疗。本研究由日本Leksell伽玛刀协会（JLGK1501）开展。
GKRS治疗后6个月和12个月，局部肿瘤复发的累积发生率分别为9.2%和13.8%。GKRS治疗中瘤内出血（p < 0.0001）和肿瘤体积较大（p = 0.001）与局部控制效果显著较差相关。GKRS治疗前使用免疫检查点抑制剂与症状性不良事件显著相关（p = 0.037）。首次GKRS治疗后的中位总生存时间为7.3个月。较低的卡氏功能状态评分（p = 0.016）、原发癌未控制（p < 0.0001）和多发脑转移（p = 0.014）显著影响总生存不良结局。GKRS治疗后6个月和12个月神经死亡的累积发生率分别为9.7%和17.4%，神经功能恶化的累积发生率分别为14.2%和19.6%，新肿瘤出现的累积发生率分别为34.5%和40.5%。
本多中心研究结果表明，GKRS是控制日本恶性黑色素瘤脑转移患者肿瘤进展的一种相对有效且安全的治疗方式。
