التفاصيل البيبلوغرافية
| العنوان: |
Significant Survival Improvements for Patients with Melanoma Brain Metastases: Can We Reach Cure in the Current Era? |
| المؤلفون: |
Berger, Assaf, Bernstein, Kenneth, Alzate, Juan Diego, Mullen, Reed, S Silverman, Joshua., Sulman, Erik, Donahue, Bernadine R., Pavlick, Anna C., Gurewitz, Jason, Mureb, Monica, Mehnert, Janice, Madden, Kathleen, Palermo, Amy, Weber, Jeffrey S., Golfinos, John G., Kondziolka, Douglas |
| المصدر: |
Journal of Radiosurgery & SBRT; 2022 Supplement, Vol. 8, p25-25, 2/3p |
| مصطلحات موضوعية: |
BRAIN metastasis, OVERALL survival, STEREOTACTIC radiosurgery, MELANOMA, SURVIVAL rate, BRAIN tumors |
| مستخلص: |
Objective: New therapeutic options for both brain metastases (BM) and extracranial melanoma care have been associated with increasing survival expectations. Ten years ago, median survivals after the diagnosis of a melanoma brain metastasis were in the range of 5 to 7 months. Using a prospective registry, our aim was to define current survival goals for melanoma patients with brain metastases, based on state-of-the-art multimodality care. Methods: We reviewed 171 consecutive melanoma patients with brain metastases receiving stereotactic radiosurgery (SRS) who were followed with point-of-care data collection between 2012-2020. Demographic, clinical, histological and imaging data were collected, including systemic treatment, radiosurgical parameters and outcomes. We evaluated factors predicting survival and tumor control, including survival without any need for systemic or local therapy. Results: The mean patient age was 65 years (20-91), 39% were female and 29% had BRAF-mutated tumors. The median overall survival after radiosurgery was 15.7 months (95% Confidence Interval [CI]: 11.4-27.7 months). We identified 32 patients who had survival of at least 5 years from an initial brain tumor radiosurgery. Patients on immunotherapy had a significantly longer survival in comparison to the rest of the population (p=0.012). BRAF mutations did not show a significant influence on survival in comparison to the wild type (p=0.2) and use of targeted therapies showed survival advantage in comparison to chemotherapy (p=0.009), but not to immunotherapy (p=0.09). In a multivariate analysis, both immunotherapy and the number of metastases treated at the first SRS were significant predictors of long-term survival of over 5 years from initial SRS (p=0.023 and p=0.018, respectively). Five patients (16%) of the long-term survivors’ cohort required no active treatment for more than 5 years. Conclusions: Long-term survival in patients with melanoma brain metastases is achievable in the current era of stereotactic radiosurgery combined with systemic immunotherapies. For those patients alive more than 5 years after first SRS for brain metastases, 16% had been also off systemic or local brain therapy for over 5 years. Given late recurrences of melanoma, caution is warranted, however prolonged survival off active treatment in a small subset of our patients raises the potential for cure. [ABSTRACT FROM AUTHOR] |
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| قاعدة البيانات: |
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