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. 2022 Jan;156(1):163-172.
doi: 10.1007/s11060-021-03899-0. Epub 2021 Nov 22.

Stereotactic radiosurgery for melanoma brain metastases: dose-size response relationship in the era of immunotherapy

Mehran Yusuf #  1 , Abbas Rattani #  2 , Jeremy Gaskins  3 , Alexandria L Oliver  4 , Steven F Mandish  5 , Eric Burton  6 , Michael E May  5 , Brian Williams  7 , Dale Ding  7 , Mayur Sharma  7 , Donald Miller  8 , Shiao Woo  5
Affiliations

Stereotactic radiosurgery for melanoma brain metastases: dose-size response relationship in the era of immunotherapy

Mehran Yusuf et al. J Neurooncol. 2022 Jan.

Abstract

Purpose/objective(s): To determine, for intact melanoma brain metastases (MBM) treated with single-fraction stereotactic radiosurgery (SRS), whether planning parameter peripheral dose per lesion diameter (PDLDm, Gy/mm) and lesion control (LC) differs with versus without immunotherapy (IO).

Materials/methods: We performed a retrospective analysis of patients with intact MBM treated with SRS from 2008 to 2019. Cox-frailty models were constructed to include confounders selected by penalized Cox regression models with a LASSO selector. Interaction effect testing was used to determine whether a significant effect between IO and PDLDm could be demonstrated with respect to LC.

Results: The study cohort comprised 67 patients with 244 MBMs treated with SRS (30 patients with 122 lesions treated with both SRS and IO) were included. The logarithm of PDLDm was selected as a predictor of LC (HR 0.307, 95% CI 0.098-0.441), adjusting for IO receipt (HR 0.363, 95% CI 0.108-1.224). Interaction effect testing demonstrated a differential effect of PDLDm by IO receipt, with respect to LC (p = 0.048). Twelve-month LC rates for a 7.5 mm lesion receiving SRS (18 Gy) with IO versus without IO were 87.8% (95% CI 69.0-98.3%) versus 79.8% (95% CI 55.1-93.8%) respectively.

Conclusion: PDLDm predicted LC in patients with small MBMs treated with single-fraction SRS. We found a differential effect of dose per lesion size and LC by immunotherapy receipt. Future studies are needed to determine whether lower doses of single-fraction SRS afford similarly effective LC for patients with small MBMs receiving immunotherapy.

Keywords: Brain metastasis; Dose; Immunotherapy; Melanoma; Size; Stereotactic radiosurgery.

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Conflict of interest statement

None.

Figures

Fig. 1
Fig. 1
a Kaplan–Meier curve comparing OS for subgroups stratified by IO receipt. b Kaplan–Meier curve comparing freedom from DBF for subgroups stratified by IO receipt. c Kaplan–Meier curve comparing freedom from LF for subgroups stratified by IO receipt. d Kaplan–Meier curve comparing freedom from symptomatic RN for subgroups stratified by IO receipt
Fig. 2
Fig. 2
Dose-Size Response (Local Control) for MBMs in cohort stratified by IO receipt
See this image and copyright information in PMC

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