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. 2022 Jun;66(4):536-545.
doi: 10.1111/1754-9485.13403. Epub 2022 Mar 27.

Stereotactic radiosurgery for melanoma brain metastases: Concurrent immune checkpoint inhibitor therapy associated with superior clinicoradiological response outcomes

Mihir D Shanker  1   2   3 , Sidyarth Garimall  2 , Nick Gatt  4 , Heath Foley  1 , Samuel Crowley  1 , Emma Le Cornu  1 , Kendall Muscat  1 , Wei Soon  2 , Victoria Atkinson  2   4 , Wen Xu  4 , Trevor Watkins  4 , Michael Huo  1   2 , Matthew C Foote  1   2 , Mark B Pinkham  1   2
Affiliations

Stereotactic radiosurgery for melanoma brain metastases: Concurrent immune checkpoint inhibitor therapy associated with superior clinicoradiological response outcomes

Mihir D Shanker et al. J Med Imaging Radiat Oncol. 2022 Jun.

Abstract

Introduction/purpose: This study assessed long-term clinical and radiological outcomes following treatment with combination stereotactic radiosurgery (SRS) and immunotherapy (IT) for melanoma brain metastases (BM).

Methods: A retrospective review was performed in a contemporary cohort of patients with melanoma BM at a single tertiary institution receiving Gamma Knife® SRS for melanoma BM. Multivariate Cox proportional-hazards modelling was performed with a P <0.05 for significance.

Results: 101 patients (435 melanoma BM) were treated with SRS between January-2015 and June-2019. 68.3% of patients received IT within 4 weeks of SRS (concurrent) and 31.7% received SRS alone or non-concurrently with IT. Overall, BM local control rate was 87.1% after SRS. Median progression free survival was 8.7 months. Median follow-up was 29.2 months. On multivariate analysis (MVA), patients receiving concurrent SRS-IT maintained a higher chance of achieving a complete (CR) or partial response (PR) [HR 2.6 (95% CI: 1.2-5.5, P = 0.012)] and a reduced likelihood of progression of disease (PD) [HR 0.52 (95% CI: 0.16-0.60), P = 0.048]. Any increase in BM volume on the initial MRI 3 months after SRS predicted a lower likelihood of achieving long-term CR or PR on MVA accounting for concurrent IT, BRAF status and dexamethasone use [HR = 0.048 (95% CI: 0.007-0.345, P = 0.0026)]. Stratified volumetric change demonstrated a sequential relationship with outcomes on Kaplan-Meier analysis.

Conclusion: Concurrent SRS-IT has favourable clinical and radiological outcomes with respect to CR, PR and a reduced likelihood of PD. Changes in BM volume on the initial MRI 3 months after SRS were predictive of long-term outcomes for treatment response.

Keywords: Gamma-Knife; brain metastases; immunotherapy; melanoma; radiosurgery.

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Figures

Fig. 1
Fig. 1
Kaplan–Meier Curve for time to progression of disease from SRS based on concurrent SRS‐IT versus non‐concurrent SRS‐IT. [Colour figure can be viewed at wileyonlinelibrary.com]
Fig. 2
Fig. 2
Kaplan–Meier Curve for time to progression of disease from SRS, stratified by initial change on 3‐month post‐SRS MRI. Green = ≥20% increase, Red = <30% decrease to <20% increase,Blue = ≥30% decrease in size. [Colour figure can be viewed at wileyonlinelibrary.com]
See this image and copyright information in PMC

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