Radiosurgery fractionation and post-treatment hemorrhage development for intact melanoma brain metastases

Purpose To assess, for intact melanoma brain metastases (MBM), whether single-fraction stereotactic radiosurgery (SRS) versus fractionated stereotactic radiotherapy (fSRT) is associated with a differential risk of post-treatment lesion hemorrhage (HA) development. Methods A single institution retros...

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Bibliographic Details
Published in:Journal of neuro-oncology 2022-12, Vol.160 (3), p.591-599
Main Authors: McKenzie, Grant, Gaskins, Jeremy, Rattani, Abbas, Oliver, Alexandria, Southall, William, Nakamura, Fumihiko, Yusuf, Mehran, Mistry, Akshitkumar, Williams, Brian, Woo, Shiao
Format: Article
Language:English
Subjects:
Brain cancer
Case Study
Dosimetry
Hemorrhage
Immunotherapy
Lesions
Medicine
Medicine & Public Health
Melanoma
Metastases
Metastasis
Neuroimaging
Neurology
Oncology
Radiation therapy
Radiosurgery
Statistical analysis
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Summary:Purpose To assess, for intact melanoma brain metastases (MBM), whether single-fraction stereotactic radiosurgery (SRS) versus fractionated stereotactic radiotherapy (fSRT) is associated with a differential risk of post-treatment lesion hemorrhage (HA) development. Methods A single institution retrospective database review identified consecutive patients with previously unresected MBM treated with robotic SRS/fSRT between 2013 and 2021. The presence of lesion HA was determined by multi-disciplinary imaging review. Dosimetric variables were reported as biologically effective doses using an α/β ratio of 2.5 (BED 2.5 ). Statistical analysis was performed using mixed effect logistic regression for post-treatment HA and Cox frailty modeling for local control (LC). Results The cohort included 48 patients with 226 intact MBM treated with SRS/fSRT. Of lesions without prior HA, 63 of 133 lesions (47.4%) receiving SRS demonstrated evidence of post-treatment HA versus 2 of 24 lesions (8.3%) treated with fSRT ( p  = 0.01). A larger maximum BED 2.5 was observed in lesions developing HA compared to no HA (238.3 Gy vs. 211.4 Gy; p  = 0.022). 12-month LC was 65.7% (95% CI 37.2–87.3%) and 77.5% (95% CI 58.5–91.2%) for lesions demonstrating pre-treatment and post-treatment HA, respectively, with no local failure events observed within 12 months for non-hemorrhagic lesions ( p  
ISSN:0167-594X
1573-7373
DOI:10.1007/s11060-022-04178-2