Does the sequence of stereotactic radiosurgery (SRS) and whole brain radiation therapy (WBRT) affect treatment related morbidity in melanoma patients with brain metastasis?

Abstract

7564 Background: For melanoma patients who develop brain metastasis, the use of SRS has become a popular option given the ease of administration and efficacy. The potential side effects of SRS have not been well documented. The purpose of this study was to determine if the sequence of SRS to WBRT affected toxicity. Methods: From January 1996 to June 2003, 33 melanoma patients (17 males and 16 females) who underwent SRS for newly diagnosed brain metastasis were retrospectively reviewed. These patients were part of an Institutional Review Board approved brain metastasis database. New neurological deficits, seizures, or the need for steroids for more than 8 weeks post-therapy were considered adverse events. The patients were grouped into 3 categories: SRS alone (SRS), WBRT followed by SRS (WBRT-SRS), and SRS followed by WBRT (SRS-WBRT). Results: The table summarizes the post-therapy adverse events. Patients with multiple lesions were more likely to have received WBRT-SRS (p=.06). 7/33 (21%) patients had multiple events. At the time of analysis, 30/33 (91%) patients had died (median survival of 6.3 months). Using multivariate analysis of gender, age, number of brain metastasis, performance status, LDH, and type of therapy, only the number of brain metastasis had an impact on overall survival (p=. 002). Conclusions: The incidence of neurologic deficits, seizures, or prolonged steroid use was common in melanoma patients with brain metastasis treated by SRS with or without WBRT. Given the small size, it was difficult to determine if the timing of SRS or the use of WBRT affected toxicity. We recommend that prospective analysis of treatment-related toxicity be performed to determine the true extent of these toxicities. No significant financial relationships to disclose.