Department of Neurological Surgery, Center for Advanced Radiosurgery, NYU Langone Health Medical Center, New York University, 530 First Avenue, New York, NY, 10016, USA.
Department of Radiation Oncology, NYU Langone Health Medical Center, New York University, New York, USA.
J Neurooncol. 2022 Jul;158(3):471-480. doi: 10.1007/s11060-022-04036-1. Epub 2022 Jun 4.
New therapies for melanoma have been associated with increasing survival expectations, as opposed to the dismal outcomes of only a decade ago. Using a prospective registry, we aimed to define current survival goals for melanoma patients with brain metastases (BM), based on state-of-the-art multimodality care.
We reviewed 171 melanoma patients with BM receiving stereotactic radiosurgery (SRS) who were followed with point-of-care data collection between 2012 and 2020. Clinical, molecular and imaging data were collected, including systemic treatment and radiosurgical parameters.
Mean age was 63 ± 15 years, 39% were female and 29% had BRAF-mutated tumors. Median overall survival after radiosurgery was 15.7 months (95% Confidence Interval 11.4-27.7) and 25 months in patients managed since 2015. Thirty-two patients survived [Formula: see text] 5 years from their initial SRS. BRAF mutation-targeted therapies showed a survival advantage in comparison to chemotherapy (p = 0.009), but not to immunotherapy (p = 0.09). In a multivariable analysis, both immunotherapy and the number of metastases at 1 SRS were predictors of long-term survival ([Formula: see text] 5 years) from initial SRS (p = 0.023 and p = 0.018, respectively). Five patients (16%) of the long-term survivors required no active treatment for [Formula: see text] 5 years.
Long-term survival in patients with melanoma BM is achievable in the current era of SRS combined with immunotherapies. For those alive [Formula: see text] 5 years after first SRS, 16% had been also off systemic or local brain therapy for over 5 years. Given late recurrences of melanoma, caution is warranted, however prolonged survival off active treatment in a subset of our patients raises the potential for cure.
新的黑色素瘤疗法的出现，使患者的生存预期得到了提高，与仅十年前相比，这是一个巨大的变化。本研究旨在通过前瞻性登记，基于最新的多模态治疗方法，为接受立体定向放射外科（SRS）治疗的脑转移（BM）黑色素瘤患者定义当前的生存目标。
我们回顾性分析了 2012 年至 2020 年间接受 SRS 治疗且进行了实时数据收集的 171 例 BM 黑色素瘤患者的临床资料。收集了包括全身治疗和放射外科参数在内的临床、分子和影像学数据。
患者平均年龄为 63±15 岁，39%为女性，29%为 BRAF 突变肿瘤。SRS 后中位总生存期为 15.7 个月（95%置信区间为 11.4-27.7），自 2015 年以来接受治疗的患者中位总生存期为 25 个月。32 例患者在初始 SRS 后生存[Formula: see text]5 年。与化疗相比，BRAF 突变靶向治疗具有生存优势（p=0.009），但与免疫治疗相比无差异（p=0.09）。多变量分析显示，免疫治疗和 SRS 时的转移数量是初始 SRS 后长期生存（[Formula: see text]5 年）的预测因素（p=0.023 和 p=0.018）。5 例（16%）长期生存者在 SRS 后 5 年内无需进行任何全身或局部脑治疗。
在 SRS 联合免疫治疗的时代，黑色素瘤脑转移患者可实现长期生存。在首次 SRS 后存活[Formula: see text]5 年的患者中，16%的患者已停止全身或局部脑治疗超过 5 年。鉴于黑色素瘤的晚期复发，需要谨慎对待，但我们患者中有一部分人在停止全身治疗后仍能长期生存，这可能提示治愈的可能性。
