Nijboer Chiel B, Piersma Djura, Sijben Angelique E J, Hoti Besim, van der Meulen Matthijs
Department of Neurology, Medisch Spectrum Twente, Enschede, the Netherlands.
Faculty of Medicine, Rijksuniversiteit Groningen, Groningen, the Netherlands.
Cancer Med. 2025 Jun;14(11):e70923. doi: 10.1002/cam4.70923.
Melanoma is one of the most common causes of brain metastases (BM). Despite recent therapeutic advances, survival in patients with brain metastases from melanoma (MBM) is dismal. In this study, we analyse the effect of concomitant treatment with stereotactic radiotherapy (SRT) and immunotherapy on survival, and of the location of BM on survival.
All patients with MBM diagnosed in Medisch Spectrum Twente, between 2011 and 2023 were included. Patient, radiological, and treatment variables were retrospectively collected. The primary outcome was overall survival (OS) and the secondary outcome was intracranial progression-free survival (IPFS). The effect of combination treatment (IRT), location, and other known prognostic factors on outcome measures was analysed using univariate and multivariate Cox regression. Location groups were divided into only supratentorial, only infratentorial, and both infra- and supratentorial BM.
92 patients with MBM were included. The mean age was 64 years with standard deviation (SD) 12, median OS [interquartile range (IQR)] was 9.8 months [4.0-31.0] in the total population. No difference in OS was found between different treatment regimens (n = 56). Patients having both infra- and supratentorial BM showed a significantly reduced OS compared to having only supratentorial BM in multivariate analysis (Hazard Ratio (HR): 2.81; 95% Confidence Interval (CI):1.37-5.74; p < 0.01). IRT had a significantly positive effect on IPFS in univariate analysis (HR: 0.32; 95% CI: 0.13-0.77; p = 0.01).
Concomitant treatment of immunotherapy and SRT is associated with a prolonged IPFS compared to immunotherapy only. Having both infra- and supratentorial BM is an independent prognostic factor for a shorter OS.
黑色素瘤是脑转移瘤（BM）最常见的病因之一。尽管近年来治疗取得了进展，但黑色素瘤脑转移（MBM）患者的生存率仍然很低。在本研究中，我们分析了立体定向放射治疗（SRT）与免疫治疗联合应用对生存率的影响，以及脑转移瘤位置对生存率的影响。
纳入2011年至2023年在特温特医学光谱中心诊断的所有MBM患者。回顾性收集患者、放射学和治疗变量。主要结局是总生存期（OS），次要结局是颅内无进展生存期（IPFS）。使用单因素和多因素Cox回归分析联合治疗（IRT）、位置和其他已知预后因素对结局指标的影响。位置组分为仅幕上、仅幕下以及幕上和幕下均有脑转移瘤。
纳入92例MBM患者。平均年龄为64岁，标准差（SD）为12，总体人群的中位OS[四分位间距（IQR）]为9.8个月[4.0 - 31.0]。不同治疗方案（n = 56）之间未发现OS有差异。在多因素分析中，幕上和幕下均有脑转移瘤的患者与仅幕上有脑转移瘤的患者相比，OS显著降低（风险比（HR）：2.81；95%置信区间（CI）：1.37 - 5.74；p < 0.01）。在单因素分析中，IRT对IPFS有显著的积极影响（HR：0.32；95% CI：0.13 - 0.77；p = 0.01）。
与单纯免疫治疗相比，免疫治疗与SRT联合治疗可延长IPFS。幕上和幕下均有脑转移瘤是OS缩短的独立预后因素。
