Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2024 Nov 15;15(1):656.
doi: 10.1007/s12672-024-01560-6.

Radiotherapy in patients with brain metastases with and without concomitant immunotherapy: comparison of patient outcome and neurotoxicity

Natalie Elyan  1 , Philipp Schwenkenbecher  2 , Lea Grote-Levi  2 , Jan-Niklas Becker  1 , Roland Merten  1 , Hans Christiansen  1 , Thomas Skripuletz  2 , Diana Steinmann  1 , Nora Möhn  3
Affiliations

Radiotherapy in patients with brain metastases with and without concomitant immunotherapy: comparison of patient outcome and neurotoxicity

Natalie Elyan et al. Discov Oncol. .

Abstract

Background/aim: Recently, immune checkpoint inhibitors (ICI) have been added to the treatment of brain metastases. While combining radiotherapy and ICI can enhance therapeutic effects, it might also increase the risk of severe autoimmune adverse events. This retrospective study aims to compare treatment responses and neurotoxicity in patients treated with radiotherapy alone versus those receiving a combination of radiotherapy and ICI.

Patients and methods: All patients with brain metastases who received radiotherapy at Hannover Medical School from 2017 to 2019 were included. The medical reports of all study participants were evaluated. Patients who received radiotherapy alone and those who received a combination of radiation and ICI were compared.

Results: A total of 248 patients were analyzed, with the most common tumor types being non-small cell lung cancer (NSCLC) and malignant melanoma. Half of the patients received whole-brain radiotherapy (WBRT) and the other half stereotactic radiotherapy (SRT). Of these, 29 patients received concurrent immunotherapy and radiotherapy, 30 completed immunotherapy before radiotherapy, and 29 started ICI after completing radiotherapy. Two cases lacked information on the duration of immunotherapy. Overall survival post-initial tumor diagnosis within the total cohort was 52 months, with significantly worse survival for patients with multiple brain metastases (p = 0.020). No significant differences in survival or incidence of neurological adverse events were observed between patients with or without ICI.

Conclusion: Combining radiotherapy and ICI did not significantly increase neurotoxicity or improve survival in this cohort, though the heterogeneity of the subgroups limits the generalizability of these findings.

Keywords: Immune checkpoint inhibitors; Neurotoxicity; Radiotherapy; Steroids.

PubMed Disclaimer

Conflict of interest statement

Declarations Ethics approval and consent to participate This retrospective study was approved by the local Ethics Committee at Hannover Medical School (Ethics Approval Number: 10950_BO_K_2023). All patients provided written informed consent for the use of their data for scientific purposes. All methods were carried out in accordance with the relevant guidelines and regulations. Competing interests The authors declare no competing interests.

Figures

Fig. 1
Fig. 1
Overall survival of patients treated with a combination of radiotherapy and immune checkpoint inhibitors (dotted curve) and patients treated with radiotherapy alone, p = 0.14
Fig. 2
Fig. 2
Illustration of the respective severity of neurotoxicity depending on the therapeutic regimen. CTCAE: common terminology criteria of adverse events
See this image and copyright information in PMC

References

    1. Lugade AA, Moran JP, Gerber SA, Rose RC, Frelinger JG, Lord EM. Local radiation therapy of B16 melanoma tumors increases the generation of tumor antigen-specific effector cells that traffic to the tumor. J Immunol. 2005;174:7516–23. - PubMed
    1. Davies MA, Liu P, McIntyre S, Kim KB, Papadopoulos N, Hwu WJ, et al. Prognostic factors for survival in melanoma patients with brain metastases. Cancer. 2011;117:1687–96. - PubMed
    1. Sperduto PW, Chao ST, Sneed PK, Luo X, Suh J, Roberge D, et al. Diagnosis-specific prognostic factors, indexes, and treatment outcomes for patients with newly diagnosed brain metastases: a multi-institutional analysis of 4,259 patients. Int J Radiat Oncol Biol Phys. 2010;77:655–61. - PubMed
    1. Cagney DN, Martin AM, Catalano PJ, Redig AJ, Lin NU, Lee EQ, et al. Incidence and prognosis of patients with brain metastases at diagnosis of systemic malignancy: a population-based study. Neuro Oncol. 2017;19:1511–21. - PMC - PubMed
    1. Mahajan A, Ahmed S, McAleer MF, Weinberg JS, Li J, Brown P, et al. Post-operative stereotactic radiosurgery versus observation for completely resected brain metastases: a single-centre, randomised, controlled, phase 3 trial. Lancet Oncol. 2017;18:1040–8. - PMC - PubMed

LinkOut - more resources