Borzillo Valentina, Di Franco Rossella, Giannarelli Diana, Cammarota Fabrizio, Scipilliti Esmeralda, D'Ippolito Emma, Petito Angela, Serra Marcello, Falivene Sara, Grimaldi Antonio M, Simeone Ester, Festino Lucia, Vanella Vito, Trojaniello Claudia, Vitale Maria Grazia, Madonna Gabriele, Ascierto Paolo A, Muto Paolo
Radiation Oncology Unit, Istituto Nazionale Tumori-IRCCS-Fondazione G. Pascale, 80131 Naples, Italy.
Statistical Unit, Regina Elena National Cancer Institute-IRCCS, 00144 Rome, Italy.
Cancers (Basel). 2021 Apr 13;13(8):1857. doi: 10.3390/cancers13081857.
The median overall survival (OS) and local control (LC) of patients with melanoma brain metastases (MBMs) are poor even with immune checkpoint inhibitors and/or radiotherapy (RT). The aims of the study were to evaluate the association and timing of stereotactic radiotherapy (SRT)/radiosurgery (SRS) performed with the CyberKnife System and ipilimumab (IPI). A total of 63 MBMs patients were analyzed: 53 received RT+IPI and 10 RT alone. Therefore, the patients were divided into four groups: RT PRE-PI (>4 weeks before IPI) (18), RT CONC-IPI (4 weeks before/between first and last cycle/within 3 months of last cycle of IPI) (20), RT POST-IPI (>3 months after IPI) (15), and NO-IPI (10). A total of 127 lesions were treated: 75 with SRS (one fraction) and 24 with SRT (three to five fractions). The median follow-up was 10.6 months. The median OS was 10.6 months for all patients, 10.7 months for RT+IPI, and 3.3 months for NO-IPI ( = 0.96). One-year LC was 50% for all patients, 56% for RT+IPI, and 18% for NO-IPI ( = 0.08). The 1-year intracranial control was 45% for all patients, 44% for RT+IPI, and 51% for NO-IPI ( = 0.73). IPI with SRS/SRT in MBMs treatment could improve LC. However, the impact and timing of the two modalities on patients' outcomes are still unclear.
即使使用免疫检查点抑制剂和/或放射治疗（RT），黑色素瘤脑转移（MBM）患者的中位总生存期（OS）和局部控制率（LC）仍较差。本研究的目的是评估使用射波刀系统进行的立体定向放射治疗（SRT）/放射外科手术（SRS）与伊匹单抗（IPI）之间的关联及时间安排。共分析了63例MBM患者：53例接受了RT+IPI治疗，10例仅接受了RT治疗。因此，患者被分为四组：RT PRE-PI（IPI前>4周）（18例）、RT CONC-IPI（IPI前4周/第一个和最后一个周期之间/最后一个周期的3个月内）（20例）、RT POST-IPI（IPI后>3个月）（15例）和NO-IPI（10例）。共治疗了127个病灶：75个采用SRS（单次分割）治疗，24个采用SRT（三至五次分割）治疗。中位随访时间为10.6个月。所有患者的中位OS为10.6个月，RT+IPI患者为10.7个月，NO-IPI患者为3.3个月（ = 0.96）。所有患者的1年LC为50%，RT+IPI患者为56%，NO-IPI患者为18%（ = 0.08）。所有患者的1年颅内控制率为45%，RT+IPI患者为44%，NO-IPI患者为51%（ = 0.73）。在MBM治疗中，IPI联合SRS/SRT可改善LC。然而，这两种治疗方式对患者预后的影响及时间安排仍不清楚。
