Abstract
PurposeStereotactic radiosurgery (SRS) alone is an increasingly common treatment strategy for brain metastases. However, existing prognostic tools for overall survival (OS) were developed using cohorts of patients treated predominantly with approaches other than SRS alone. Therefore, we devised novel risk scores for OS and distant brain failure (DF) for melanoma brain metastases (MBM) treated with SRS alone.Methods and materialsWe retrospectively reviewed 86 patients treated with SRS alone for MBM from 2009-2014. OS and DF were estimated using the Kaplan-Meier method. Cox proportional hazards modeling identified clinical risk factors. Risk scores were created based on weighted regression coefficients. OS scores range from 0-10 (0 representing best OS), and DF risk scores range from 0-5 (0 representing lowest risk of DF). Predictive power was evaluated using c-index statistics. Bootstrapping with 200 resamples tested model stability.ResultsThe median OS was 8.1 months from SRS, and 54 (70.1 %) patients had DF at a median of 3.3 months. Risk scores for OS were predicated on performance status, extracranial disease (ED) status, number of lesions, and gender. Median OS for the low-risk group (0-3 points) was not reached. For the moderate-risk (4-6 points) and high-risk (6.5-10) groups, median OS was 7.6 months and 2.4 months, respectively (p < .0001). Scores for DF were predicated on performance status, ED status, and number of lesions. Median time to DF for the low-risk group (0 points) was not reached. For the moderate-risk (1-2 points) and high-risk (3-5 points) groups, time to DF was 4.8 and 2.0 months, respectively (p < .0001). The novel scores were more predictive (c-index = 0.72) than melanoma-specific graded prognostic assessment or RTOG recursive partitioning analysis tools (c-index = 0.66 and 0.57, respectively).ConclusionsWe devised novel risk scores for MBM treated with SRS alone. These scores have implications for prognosis and treatment strategy selection (SRS versus whole-brain radiotherapy).
Highlights
Melanoma brain metastases (MBM) are a common type of secondary intracranial neoplasm and will develop in nearly half of patients with advanced cutaneous melanoma [1,2,3]
Risk scores for overall survival (OS) were predicated on performance status, extracranial disease (ED) status, number of lesions, and gender
Scores for distant brain failure (DF) were predicated on performance status, ED status, and number of lesions
Summary
Melanoma brain metastases (MBM) are a common type of secondary intracranial neoplasm and will develop in nearly half of patients with advanced cutaneous melanoma [1,2,3]. The rate of MBM is likely to rise given the increasing incidence of melanoma and advances in systemic disease control with targeted therapies [4, 5]. Radiotherapy treatment options for MBM include whole-brain radiation therapy (WBRT) and stereotactic radiosurgery (SRS) [8]. WBRT irradiates both the known metastases and potential microscopic disease — maximizing intracranial control but at the cost of neurotoxicity [7, 9,10,11,12,13,14]. While the optimal strategy remains controversial, SRS alone is an increasingly common treatment approach, for patients with a limited volume of metastatic disease [20]
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