Department of Radiation Oncology, Klinikum rechts der Isar, Technical University Munich (TUM), Ismaninger Straße 22, 81675, Munich, Germany.
Institute of Radiation Medicine (IRM), Helmholtz Zentrum München, Neuherberg, Germany.
Clin Transl Oncol. 2021 Oct;23(10):2020-2029. doi: 10.1007/s12094-021-02607-8. Epub 2021 May 15.
Malignant melanoma is the third most common primary in the diagnosis of brain metastases. Stereotactic radiosurgery (SRS) is a well-established treatment option in limited brain disease. We analyzed outcomes of SRS with a particular focus on the graded prognostic assessment (GPA, melanoma molGPA), prognostic factors, and toxicity.
We evaluated 173 brain metastases in 83 patients with malignant melanoma. All were treated with SRS median dose of 20 Gy prescribed to the 80 or 100% isodose line between 2002 and 2019. All patients were followed-up regularly, including contrast-enhanced brain imaging as well as clinical examination, initially 6 weeks after treatment, then in quarterly follow-up.
The median age was 61 years (range 27-80); 36 female and 47 male patients were treated. After a median follow-up of 5.7 months, median OS (overall survival) was 9.7 months 95%-KI 4.7-14.7). LC (local control) at 6 months, 12, 24 months was 89%, 86%, and 72%, respectively (median was not reached). Median DBC (distant brain control) was 8.2 months (95%-KI 4.7-11.7). For OS, a KPS ≥ 80%, a positive BRAF mutation status, a small PTV (planning target volume), the absence of extracranial metastases, as well as a GPA and melanoma molGPA > 2 were prognostic factors. In the MVA, a small PTV and a melanoma molGPA > 2 remained significant.
The present survival outcomes support the use of the disease-specific melanoma molGPA as reliable prognostic score. Favorable outcomes for SRS compared to other studies were observed. In the treatment of brain metastases of malignant melanoma patients, a multidisciplinary approach consisting of surgery, SRS, chemotherapy, and immunotherapy should be considered.
恶性黑色素瘤是脑转移瘤诊断中的第三大常见原发性肿瘤。立体定向放射外科（SRS）是治疗局限性脑疾病的一种成熟的治疗选择。我们分析了 SRS 的结果，特别关注分级预后评估（GPA，黑色素瘤 molGPA）、预后因素和毒性。
我们评估了 83 例恶性黑色素瘤患者的 173 个脑转移瘤。所有患者均采用 SRS 治疗，中位剂量为 20 Gy，在 2002 年至 2019 年期间，处方至 80%或 100%等剂量线。所有患者均定期随访，包括增强脑成像以及临床检查，最初在治疗后 6 周进行，然后每季度进行一次。
中位年龄为 61 岁（范围 27-80）；36 名女性和 47 名男性患者接受了治疗。中位随访 5.7 个月后，中位总生存期（OS）为 9.7 个月（95%CI 4.7-14.7）。6 个月、12 个月和 24 个月时的局部控制（LC）率分别为 89%、86%和 72%（中位未达到）。中位远处脑控制（DBC）为 8.2 个月（95%CI 4.7-11.7）。对于 OS，KPS≥80%、BRAF 突变阳性、较小的 PTV（计划靶区）、无颅外转移以及 GPA 和黑色素瘤 molGPA>2 是预后因素。在 MVA 中，较小的 PTV 和黑色素瘤 molGPA>2 仍然具有显著性。
目前的生存结果支持使用特定于疾病的黑色素瘤 molGPA 作为可靠的预后评分。与其他研究相比，SRS 的观察结果较为有利。在恶性黑色素瘤脑转移患者的治疗中，应考虑手术、SRS、化疗和免疫治疗相结合的多学科方法。
