Li Kelly H, Cheung Patrick Cf, Petrella Teresa M, Zhang Liying, Poon Ian Dt, Menjak Ines B
Department of Medical Oncology BC Cancer Agency Vancouver Canada.
Department of Radiation Oncology Odette Cancer Centre, Toronto, Sunnybrook Health Sciences Centre Toronto Canada.
Precis Radiat Oncol. 2024 Mar 24;8(2):62-69. doi: 10.1002/pro6.1224. eCollection 2024 Jun.
This study aimed to summarize the clinical outcomes of patients with metastatic melanoma who received high-dose radiation prior to or during systemic therapy at a single academic institution.
We identified patients with metastatic melanoma who underwent high-dose radiation therapy (HDRT) for extracranial metastases prior to or during systemic therapy from 2010 to 2018. Treatment indications included oligometastases, oligoprogression, and local control. Using the Kaplan-Meier method, we plotted overall survival (OS), progression-free survival-1 (PFS1), and PFS2. Competing risk analysis determined the cumulative incidence of local failure (LF) and the time to start or change systemic therapy (SCST). Univariate and multivariable analyses were used to identify predictive factors.
We analyzed 34 patients with 79 lesions, with a median follow-up of 17.4 months. Sixty-eight percent of patients received systemic therapy after the first HDRT. The median OS was 22 months, with brain metastases before HDRT being a significant predictor in multivariable analysis. The median PFS1 for first-line HDRT was 4.1 months, and the median PFS2 was 3.9 months. Rates of LF were 10.3% at 12 months and 11.7% at 24 months. The incidence of SCST following HDRT was 59.8% at 12 months and 76.1% at 24 months, with radiation targeted at the lung associated with a lower incidence of SCST.
HDRT for treating metastatic lesions in melanoma demonstrated excellent local control and may play a role in delaying SCST. Additional courses of HDRT may provide cumulative benefits.
本研究旨在总结在单一学术机构接受全身治疗之前或期间接受高剂量放疗的转移性黑色素瘤患者的临床结局。
我们确定了2010年至2018年期间在全身治疗之前或期间因颅外转移接受高剂量放射治疗（HDRT）的转移性黑色素瘤患者。治疗指征包括寡转移、寡进展和局部控制。使用Kaplan-Meier方法，我们绘制了总生存期（OS）、无进展生存期1（PFS1）和PFS2。竞争风险分析确定了局部失败（LF）的累积发生率以及开始或改变全身治疗（SCST）的时间。单因素和多因素分析用于确定预测因素。
我们分析了34例患者的79个病灶，中位随访时间为17.4个月。68%的患者在首次HDRT后接受了全身治疗。中位OS为22个月，在多因素分析中，HDRT前有脑转移是一个显著的预测因素。一线HDRT的中位PFS1为4.1个月，中位PFS2为3.9个月。LF发生率在12个月时为10.3%，在24个月时为11.7%。HDRT后SCST的发生率在12个月时为59.8%，在24个月时为76.1%，针对肺部的放疗与较低的SCST发生率相关。
HDRT治疗黑色素瘤转移灶显示出良好的局部控制，可能在延迟SCST方面发挥作用。额外疗程的HDRT可能会带来累积益处。
