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. 2021 Oct;23(10):2020-2029.
doi: 10.1007/s12094-021-02607-8. Epub 2021 May 15.

Outcomes after stereotactic radiosurgery of brain metastases in patients with malignant melanoma and validation of the melanoma molGPA

K A Kessel #  1   2   3 , A Deichl #  4 , J Gempt  3   5 , B Meyer  3   5 , C Posch  6   7 , C Diehl  1   3 , C Zimmer  3   8 , S E Combs  1   2   3
Affiliations

Outcomes after stereotactic radiosurgery of brain metastases in patients with malignant melanoma and validation of the melanoma molGPA

K A Kessel et al. Clin Transl Oncol. 2021 Oct.

Abstract

Introduction: Malignant melanoma is the third most common primary in the diagnosis of brain metastases. Stereotactic radiosurgery (SRS) is a well-established treatment option in limited brain disease. We analyzed outcomes of SRS with a particular focus on the graded prognostic assessment (GPA, melanoma molGPA), prognostic factors, and toxicity.

Methods: We evaluated 173 brain metastases in 83 patients with malignant melanoma. All were treated with SRS median dose of 20 Gy prescribed to the 80 or 100% isodose line between 2002 and 2019. All patients were followed-up regularly, including contrast-enhanced brain imaging as well as clinical examination, initially 6 weeks after treatment, then in quarterly follow-up.

Results: The median age was 61 years (range 27-80); 36 female and 47 male patients were treated. After a median follow-up of 5.7 months, median OS (overall survival) was 9.7 months 95%-KI 4.7-14.7). LC (local control) at 6 months, 12, 24 months was 89%, 86%, and 72%, respectively (median was not reached). Median DBC (distant brain control) was 8.2 months (95%-KI 4.7-11.7). For OS, a KPS ≥ 80%, a positive BRAF mutation status, a small PTV (planning target volume), the absence of extracranial metastases, as well as a GPA and melanoma molGPA > 2 were prognostic factors. In the MVA, a small PTV and a melanoma molGPA > 2 remained significant.

Conclusion: The present survival outcomes support the use of the disease-specific melanoma molGPA as reliable prognostic score. Favorable outcomes for SRS compared to other studies were observed. In the treatment of brain metastases of malignant melanoma patients, a multidisciplinary approach consisting of surgery, SRS, chemotherapy, and immunotherapy should be considered.

Keywords: Brain metastases; GPA; Melanoma; Prognostic factors; Radiosurgery; SRS.

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Conflict of interest statement

No conflicts of interest.

Figures

Fig. 1
Fig. 1
Survival curves for BRAF mutation status (p = 0.004)
Fig. 2
Fig. 2
Survival curves for the melanoma molGPA (p = 0.001)
Fig. 3
Fig. 3
Survival curves for the initial GPA (p = 0.043)
See this image and copyright information in PMC

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