Singh Raj, Bishop Sophia, Jenkins Jan, Davis Joanne, Lehrer Eric J, Baliga Sujith, Palmer Joshua D, Vargo John A, McLaughlin Christopher M, Gogineni Emile, Sharma Sanjeev
Ohio State University Comprehensive Cancer Center, Department of Radiation Oncology, Columbus, OH, USA.
Radiosurgery Society, San Jose, CA, USA.
J Radiosurg SBRT. 2025;9(3):199-205.
To report on local control (LC), toxicity, and overall survival (OS) following stereotactic ablative radiation therapy (SABR) for extracranial metastases from malignant melanoma.
The RSSearch Patient Registry was searched for patients with extracranial melanoma metastases treated with SABR. LC was defined as the time from completion of SABR to the date of last radiographic follow-up with either stability or decrease in size of the treated metastasis or the date at which lesion growth was radiographically confirmed per RECIST criteria. Kaplan-Meier analyses were utilized to evaluate potential prognostic factors on univariate analyses (UVA) with log-rank tests followed by use of a Cox proportional hazards multivariate (MVA) model.
There were 45 patients with 52 extracranial melanoma metastases treated with SABR. One- and 2-year LC rates were both 85.3% (95% CI: 67.9-93.7%) following SABR. On UVA, BED10 < 60 Gy was associated with poorer 1-year and 2-year LC (96% vs. 61.9%), which remained significant on MVA (hazard ratio [HR] = 7.06; p = 0.03). On UVA, pulmonary vs. non-pulmonary metastases were correlated with 1-year OS (84.5% vs. 57.4%; p = 0.05) and non-spinal vs. spinal metastases (74.3% vs. 56.3%; p = 0.02), though neither were significant on MVA. The incidence of treatment-related toxicity was 18.9%, all Grade 1-2.
We recommend dose/fractionation schedules that meet or exceed BED10 ≥ 60 Gy when treating extracranial melanoma metastases with SABR.
报告立体定向消融放疗（SABR）治疗恶性黑色素瘤颅外转移灶后的局部控制（LC）、毒性反应及总生存期（OS）。
在RSSearch患者登记系统中搜索接受SABR治疗的颅外黑色素瘤转移患者。LC定义为从SABR完成至最后一次影像学随访日期，此时治疗的转移灶大小稳定或缩小，或根据RECIST标准影像学确认病变生长的日期。采用Kaplan-Meier分析进行单因素分析（UVA）以评估潜在预后因素，采用对数秩检验，随后使用Cox比例风险多因素（MVA）模型。
45例患者共52个颅外黑色素瘤转移灶接受了SABR治疗。SABR后1年和2年LC率均为85.3%（95%CI：67.9 - 93.7%）。在UVA中，生物等效剂量10（BED10）<60 Gy与较差的1年和2年LC相关（96%对61.9%），在MVA中仍具有显著性（风险比[HR]=7.06；p = 0.03）。在UVA中，肺转移与非肺转移与1年OS相关（84.5%对57.4%；p = 0.05），非脊柱转移与脊柱转移（74.3%对56.3%；p = 0.02），但在MVA中均无显著性。治疗相关毒性反应发生率为18.9%，均为1 - 2级。
我们建议在用SABR治疗颅外黑色素瘤转移灶时，采用达到或超过BED10≥60 Gy的剂量/分割方案。
