Fu Allen Ye, Bernstein Kenneth, Zhang Jeff, Silverman Joshua, Mehnert Janice, Sulman Erik P, Oermann Eric Karl, Kondziolka Douglas
New York University Grossman School of Medicine, 550 1st Ave, New York, NY, 10016, USA.
Department of Radiation Oncology, NYU Langone Health, New York University, New York, NY, USA.
J Neurooncol. 2025 Apr 4. doi: 10.1007/s11060-025-05026-9.
Immune checkpoint inhibition (ICI) has revolutionized the treatment of melanoma care. Stereotactic radiosurgery combined with ICI has shown promise to improve clinical outcomes in prior studies in patients who have metastatic melanoma with brain metastases. However, others have suggested that concurrent ICI with stereotactic radiosurgery can increase the risk of complications.
We present a retrospective, single-institution analysis of 98 patients with a median follow up of 17.1 months managed with immune checkpoint inhibition and stereotactic radiosurgery concurrently and non-concurrently. A total of 55 patients were included in the concurrent group and 43 patients in the non-concurrent treatment group. Cox proportional hazards models were used to assess the relation between concurrent or non-concurrent treatment and overall survival or local progression-free survival. The Wald test was used to assess significance. Significant differences between patients in both groups experiencing adverse events including adverse radiation effects, perilesional edema, and neurological deficits were tested for using the Chi-square or Fisher's exact test.
Patients receiving concurrent versus non-concurrent ICI showed a significant increase in overall survival (median 37.1 months, 95% CI: 18.9 months - NA versus median 11.4 months, 95% CI: 6.4-33.2 months, p = 0.0056) but not local progression-free survival. There were no significant differences between groups with regards to adverse radiation effects (2% versus 3%), perilesional edema (20% versus 9%), neurological deficits (3% versus 20%).
These results suggest that the timing of ICI does not increase risk of neurological complications when delivered within 4 weeks of SRS.
免疫检查点抑制（ICI）彻底改变了黑色素瘤的治疗方式。在先前针对有脑转移的转移性黑色素瘤患者的研究中，立体定向放射外科联合ICI已显示出改善临床结局的前景。然而，其他人认为ICI与立体定向放射外科同时进行会增加并发症风险。
我们进行了一项回顾性、单机构分析，纳入98例患者，中位随访时间为17.1个月，这些患者接受了免疫检查点抑制与立体定向放射外科同时或不同时治疗。同时治疗组共纳入55例患者，非同时治疗组纳入43例患者。采用Cox比例风险模型评估同时或不同时治疗与总生存期或局部无进展生存期之间的关系。采用Wald检验评估显著性。使用卡方检验或Fisher精确检验对两组发生不良事件（包括放射不良反应、瘤周水肿和神经功能缺损）的患者之间的显著差异进行检验。
接受同时与不同时ICI治疗的患者总生存期显著延长（中位生存期37.1个月，95%置信区间：18.9个月 - 未定义 对比 中位生存期11.4个月，95%置信区间：6.4 - 33.2个月，p = 0.0056），但局部无进展生存期无显著差异。两组在放射不良反应（2%对3%）、瘤周水肿（20%对9%）、神经功能缺损（3%对20%）方面无显著差异。
这些结果表明，当在立体定向放射外科治疗后4周内进行ICI治疗时，其时间安排不会增加神经并发症的风险。
