scholarly journals Surgical management of melanoma brain metastases in patients treated with immunotherapy

2011 ◽  
Vol 115 (1) ◽  
pp. 30-36 ◽  
Author(s):  
Russell R. Lonser ◽  
Debbie K. Song ◽  
Jacob Klapper ◽  
Marygrace Hagan ◽  
Sungyoung Auh ◽  
...  
Keyword(s):  
Brain Metastasis ◽  
Brain Metastases ◽  
Metastatic Melanoma ◽  
Objective Response ◽  
Median Number ◽  
Recurrence Rates ◽  
Whole Brain Radiation ◽  
Significant Survival ◽  
Melanoma Brain Metastases ◽  
Brain Radiation

Object Despite the increasing use of immunotherapy in the treatment of metastatic melanoma, the effects of this therapy on the management of patients with associated brain metastases are not completely defined. The authors undertook this study to determine the effectiveness of resection and the effects of immunotherapy on brain metastasis management. Methods The authors analyzed data pertaining to consecutive patients with metastatic melanoma treated with immunotherapy within 3 months of discovery of brain metastases that were surgically resected. Results Forty-one patients (median age 44.4 years, range 19.2–63.1 years) underwent resection of 53 brain metastases (median number of metastases 1, range 1–4). The median metastasis volume was 2.5 cm3. Fifteen patients underwent whole-brain radiation therapy (WBRT) and 26 patients did not. Duration of survival from brain metastasis diagnosis was not significantly different between patients who received WBRT (mean 24.9 months) and those who did not (mean 23.3 months) (p > 0.05). Local and distant brain recurrence rates were not statistically different between the WBRT (7.1% and 28.6%, respectively) and non-WBRT (7.7% and 41.0%) groups for the duration of follow-up (p > 0.05). An objective systemic response to immunotherapy was associated with increased duration of survival (p < 0.05). Conclusions Resection of melanoma brain metastases in patients treated with immunotherapy provides excellent local control with low morbidity. An objective response to systemic immunotherapy is associated with a prolonged survival in patients who have undergone resection of melanoma brain metastases. Moreover, adjuvant WBRT in melanoma immunotherapy patients with limited metastatic disease to the brain does not appear to provide a significant survival benefit.

Radiosurgery alone for solitary and multiple brain metastasis

2006 ◽  
Vol 24 (18_suppl) ◽  
pp. 1541-1541
Author(s):  
J. L. Fox ◽  
L. Kleinberg ◽  
S. Kharkar ◽  
R. E. Clatterbuck ◽  
P. Wang ◽  
...  
Keyword(s):  
Brain Metastases ◽  
Median Number ◽  
Rank Test ◽  
Small Cell Lung ◽  
Treatment Groups ◽  
Time Commitment ◽  
Whole Brain Radiation ◽  
Log Rank Test ◽  
Brain Radiation

1541 Background: Whole-brain radiation (WBRT) in the management of brain metastases treated with radiosurgery (RS) is controversial. Methods: Ninety-eight patients were treated for brain metastases with RS at Johns Hopkins between 4/03 and 7/05. Twenty-eight patients received RS alone after failing WBRT, 33 received RS alone for initial metastases and 37 received RS along with WBRT. Forty-five patients were women and 53 were men, with a median age of 56 (range, 18–92). Histology was: non-small cell lung cancer - 35, breast -14, melanoma -10, renal cell carcinoma - 9, and other - 30. Ninety-two (94%) pts had a KPS of ≥ 70 (median 80). The median number of metastases was 2 (range, 1–14). Results: Follow-up data from date of RS was available for 96 patients. Among those who received RS along with planned WBRT, median survival (MS) was 6.6 months with 1-yr overall survival (OS) 38%. Among patients treated initially with RS alone, MS was 9.7 months with 1-yr OS 42%. Among patients treated with RS for recurrent metastases after prior WBRT, MS was 6.8 months with 1-yr OS 24%. There were no significant differences in survival amongst these 3 treatment groups (p=0.73, log-rank test). For patients with 1–3 metastases (n=66), 1-yr OS was 38% versus 32% for those with ≥ 4 (n=32). Median survivals were 8.4 and 6.7 months, respectively (p=NS). Of patients treated with RS for recurrence, 7 of 25 (28%) with available follow-up data developed recurrent or new metastases whereas 11/27 (41%) treated with RS and planned WBRT and 15/27 (56%) who had RS alone as initial treatment had documented recurrent or new metastases. Conclusions: RS alone may be an effective treatment that preserves survival for those with single or multiple brain metastases at initial presentation or recurrence, but the tradeoff between the marginal increase in risk of brain recurrence versus toxicity and time commitment for WBRT needs further evaluation. The ongoing US Intergroup randomized trial, N0572/Z300, will address some of these questions. No significant financial relationships to disclose.

scholarly journals The role of whole brain radiation therapy in the management of melanoma brain metastases

2014 ◽  
Vol 9 (1) ◽  
pp. 143 ◽  
Author(s):  
Michael A Dyer ◽  
Nils D Arvold ◽  
Yu-Hui Chen ◽  
Nancy E Pinnell ◽  
Timur Mitin ◽  
...  
Keyword(s):  
Radiation Therapy ◽  
Brain Metastases ◽  
Whole Brain Radiation Therapy ◽  
Whole Brain ◽  
Whole Brain Radiation ◽  
Melanoma Brain Metastases ◽  
Brain Radiation

scholarly journals RADI-27. ROLE OF STEREOTACTIC RADIOSURGERY IN THE CARE OF PATIENTS WITH >/= 25 CUMULATIVE BRAIN METASTASES

2019 ◽  
Vol 1 (Supplement_1) ◽  
pp. i27-i27
Author(s):  
Carolina Benjamin ◽  
Monica Mureb ◽  
Bernadine Donahue ◽  
Erik Sulman ◽  
Joshua Silverman ◽  
...  
Keyword(s):  
Brain Metastases ◽  
Stereotactic Radiosurgery ◽  
Tumor Volume ◽  
Median Number ◽  
Median Dose ◽  
Total Tumor Volume ◽  
Whole Brain Radiation ◽  
Brain Radiation

Abstract INTRODUCTION: Stereotactic radiosurgery (SRS) is an accepted treatment for multiple brain metastases. However, the upper limit of the number of brain metastases over the course of care suitable for this approach is controversial. METHODS: From a review of our prospective registry, 48 patients treated with SRS for ≥ 25 brain metastases in either single or multiple sessions between 2013 and 2019 were identified. Patient, tumor, and treatments characteristics were evaluated. Clinical outcomes and overall survival (OS) were analyzed. RESULTS: Thirty-one females (64.6%) and 17 males (35.4%) with a median age of 56 years (25–91) were included. Primary diagnoses included lung (n=23, 47.9%), breast (n=13, 27.1%), melanoma (n=8, 16.7%), and other (n=4, 8.33%). Initial median GPA index was 2 (0.5–3). Nine patients (18.8%) had received whole brain radiation therapy (WBRT) prior to first SRS treatment, with a median dose of 35Gy (30–40.5Gy). Ten patients (20.8%) received WBRT after initial SRS, with a median dose of 30Gy (20-30Gy). Thus, only 19 patients (40%) ever received WBRT. Median number of radiosurgeries per patient was 3 (1–12). Median number of cumulative tumors irradiated was 31 (25–110). Median number of tumors irradiated at first SRS was 10 (1–35). Median marginal dose for the largest tumor per session was 16Gy (10-21Gy). Median SRS total tumor volume was 6.8cc (0.8–23.4). Median follow-up since initial SRS was 16 months (1–71). At present, 21 (43.7%) are alive. Median OS from the diagnosis of brain metastases was 31 months (2–97), and OS from the time of first SRS, 22 months (1–70). Median KPS at first SRS and last follow-up was the same (90). Sixty-three percent did not require a corticosteroid course. CONCLUSION: In selected patients with a large number of cumulative brain metastases (≥ 25), SRS is effective and safe. Therefore, WBRT may not be required in this population.

scholarly journals Contemporary Review of the Management of Brain Metastasis with Radiation

2015 ◽  
Vol 2015 ◽  
pp. 1-13 ◽  
Author(s):  
Deepak Khuntia
Keyword(s):  
Brain Metastasis ◽  
Brain Metastases ◽  
Standard Treatment ◽  
Review Article ◽  
Morbidity And Mortality ◽  
Neurocognitive Deficits ◽  
Whole Brain ◽  
Whole Brain Radiation ◽  
Novel Approaches ◽  
Brain Radiation

Brain metastases are an important cause of morbidity and mortality, afflicting approximately 200,000 Americans annually. The prognosis for these patients is poor, with median survivals typically measured in months. In this review article, we present the standard treatment approaches with whole brain radiation and as well as novel approaches in the prevention of neurocognitive deficits.

scholarly journals NCOG-05. MANAGEMENT OF BRAIN METASTASIS IN TRIPLE NEGATIVE BREAST CANCER

2020 ◽  
Vol 22 (Supplement_2) ◽  
pp. ii130-ii130
Author(s):  
Ravi Medikonda ◽  
Siddhartha Srivastava ◽  
Timothy Kim ◽  
Yuanxuan Xia ◽  
Mira Patel ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Overall Survival ◽  
Radiation Therapy ◽  
Brain Metastasis ◽  
Brain Metastases ◽  
Triple Negative Breast Cancer ◽  
Triple Negative ◽  
Whole Brain ◽  
Whole Brain Radiation ◽  
Brain Radiation

Abstract Brain metastasis is common in patients with breast cancer, and those with triple negative status have an even higher risk. Stereotactic radiosurgery (SRS) is preferred to whole brain radiation therapy (WBRT) in most patients. However, triple negative status is currently not considered when determining optimal radiation therapy. Given the aggressive nature of triple negative breast cancer, we evaluated a role for WBRT for all patients in this cohort. We conducted a single-institution retrospective cohort study to determine whether triple negative patients with brain metastases have a higher burden of intracranial disease and whether type of initial radiation therapy affects overall survival for this cohort of patients. 85 patients met the inclusion criteria for this study. 25% of patients had triple negative breast cancer, of which 91% received SRS and 53% of patients received WBRT. The average number of new brain metastases from time of initial brain imaging to radiation therapy was 0.67 (St.Dev:1.1) in the non-triple negative status patients and 2.6 (St. Dev:3.7) in the triple negative status patients (p=0.001). Using a cox proportional hazards model, it was found that whole brain radiotherapy does not significantly affect overall survival in patients with triple negative breast cancer (p = 0.96). Our findings highlight the highly aggressive intracranial nature of triple negative breast cancer. Indeed, the rate of increase in brain metastases is significantly higher for triple negative patients compared to non-triple negative patients. As a result, we evaluated whether triple negative patients would benefit from whole brain radiation regardless of findings on initial brain imaging. Despite 53% of patients receiving WBRT, our investigation found that there is no additional benefit to WBRT in triple negative breast cancer patients. These results suggest a need to re-evaluate the role of WBRT in the management of triple negative breast cancer.

Effect of immunotherapy and stereotactic radiosurgery on cognitive function and quality of life in long term survivors of metastatic brain malignancies.

2018 ◽  
Vol 36 (7_suppl) ◽  
pp. 125-125
Author(s):  
Naveen Kumar Reddy ◽  
Franklin Brown ◽  
Judith Hess ◽  
Miklos C. Fogarasi ◽  
Veronica Chiang
Keyword(s):  
Quality Of Life ◽  
Executive Function ◽  
Cognitive Function ◽  
Brain Metastasis ◽  
Brain Metastases ◽  
Processing Speed ◽  
Whole Brain Radiation ◽  
Brain Radiation

125 Background: Use of whole brain radiation, radiosurgery, targeted therapies, and more recently, immunotherapies have resulted in improved survival for patients with brain metastases. As patients live longer, it is becoming increasingly important to understand the long-term cognitive function (CF) and quality of life (QOL) changes associated with these therapies. Methods: The Yale Gamma Knife Database was searched for patients surviving greater than 2 years after brain metastasis diagnosis. Of 79 patients identified, 19 were willing to participate in study. All participants underwent a single assessment session of cognitive tests that evaluated executive function (TMTa and TMTb), processing speed (COWA), memory (HVLT), and quality of life (FACT-Br). Results: Within the whole group, mean age was 65.5 years (range 50-88), median time from brain metastasis diagnosis to testing was 60 months (range 25.6-120.6). Mean number of lesions treated was 3.8 (range 1-10). Mean total lesion volume treated was 14.1 mm3 (range 0.6 - 39). Only 2 patients were treated with whole brain radiation therapy. Patient scores were compared to validated normative data for their age group. Patients performed worse than normal for their age on TMTb (p < 0.0001), total word recall (p < 0.0001) and discriminative ability (p = 0.0004). Patients performed as expected for age on TMTa, animal naming, FAS, and % retention. A negative correlation was seen between executive function results and QOL (TMTa: r = -0.569, p ≤ 0.05, TMTb: r = -0.484, p ≤ 0.05) and a positive correlation was seen between processing speed results and QOL (r = 0.672, p ≤ 0.001). Conclusions: In patients surviving more than 2 years after diagnosis and successful treatment of brain metastases, this study shows that portions of executive function and memory are worse than expected for their age, while cognitive processing speed is similar to norms. Cognitive function was correlated with QOL; patients with lowered cognitive function reported a lower quality of life. Given this preliminary data, a further study in a larger population is needed to determine if certain treatments preferentially predispose patients to declines in CF and QOL.

scholarly journals Ipilimumab and whole brain radiation therapy for melanoma brain metastases

2014 ◽  
Vol 121 (1) ◽  
pp. 159-165 ◽  
Author(s):  
Naamit K. Gerber ◽  
Robert J. Young ◽  
Christopher A. Barker ◽  
Jedd D. Wolchok ◽  
Timothy A. Chan ◽  
...  
Keyword(s):  
Radiation Therapy ◽  
Brain Metastases ◽  
Whole Brain Radiation Therapy ◽  
Whole Brain ◽  
Whole Brain Radiation ◽  
Melanoma Brain Metastases ◽  
Brain Radiation

Results of Whole Brain Radiation Therapy in Patients with Brain Metastases from Colorectal Carcinoma

2005 ◽  
Vol 91 (2) ◽  
pp. 163-167 ◽  
Author(s):  
Maurizio Amichetti ◽  
Giancarlo Lay ◽  
Marina Dessì ◽  
Silvia Orrù ◽  
Roberta Farigu ◽  
...  
Keyword(s):  
Colorectal Cancer ◽  
Radiation Therapy ◽  
Brain Metastasis ◽  
Brain Metastases ◽  
Survival Time ◽  
Whole Brain Radiation Therapy ◽  
Whole Brain ◽  
Whole Brain Radiation ◽  
Brain Radiation ◽  
The Brain

Aims and background Carcinoma of the colon-rectum is an infrequent cause of brain metastases, constituting 1-5% of all metastatic lesions to the brain. We reviewed our experience in the treatment of brain metastases from colorectal cancer to define the efficacy of whole brain radiation therapy as a palliative measure in this setting of patients. Methods Twenty-three consecutive cases of brain metastasis from colorectal cancer treated between 1999 and 2004 were identified in the files of the Division of Radiotherapy of the A Businco Regional Oncological Hospital, Cagliari. Their records were reviewed for patient and tumor characteristics and categorized according to the RTOG RPA classes. Results Fifteen patients (65%) had multiple metastases. Twenty-one patients (91%) showed extracranial metastases. Fourteen patients were classified as RTOG RPA class II and 9 class III. The median radiation dose delivered was 2000 cGy in 5 fractions in one week (range, 20-36 Gy). In 14 of 20 assessable patients (70%), symptomatic improvement was observed. The median follow-up and survival time for all the patients, 12 females and 11 males, was 3 months. In 3 patients only the cause of death was the brain metastasis. Conclusions Despite the disappointing survival time, external radiation therapy to the whole brain proved to be an efficacious palliative treatment for patients with multiple or inoperable brain metastasis from colorectal cancer.

Predicting Tumor Control After Resection Bed Radiosurgery of Brain Metastases

Neurosurgery ◽  
2013 ◽  
Vol 73 (6) ◽  
pp. 1001-1006 ◽  
Author(s):  
Neal Luther ◽  
Douglas Kondziolka ◽  
Hideyuki Kano ◽  
Seyed H. Mousavi ◽  
Johnathan A. Engh ◽  
...  
Keyword(s):  
Radiation Therapy ◽  
Brain Metastasis ◽  
Brain Metastases ◽  
Tumor Progression ◽  
Local Control ◽  
Progression Free Survival ◽  
Tumor Control ◽  
Free Survival ◽  
Whole Brain Radiation ◽  
Brain Radiation

Abstract BACKGROUND: Stereotactic radiosurgery (SRS) to the resection bed of a brain metastasis is an important treatment option. OBJECTIVE: To identify factors associated with tumor progression after SRS of the resection bed of a brain metastasis and to evaluate patterns of failure for patients who eventually had tumor progression. METHODS: We performed a retrospective analysis of 120 patients who underwent tumor bed radiosurgery after an initial gross total resection. The mean imaging follow-up time was 55 weeks. The median margin dose was 16 Gy. Forty-seven patients (39.2%) underwent whole-brain radiation therapy before or shortly after SRS. RESULTS: Local tumor control was achieved in 103 patients (85.8%). Progression-free survival was 96% at 6 months, 87% at 12 months, and 74% at 24 months. Recurrence most commonly occurred deep in the cavity (65%) outside the planned treatment volume (PTV) margin (53%). PTV, cavity diameter, and a margin dose &lt; 16 Gy significantly correlated with local failure. For patients with PTVs ≥ 8.0 cm3, local progression-free survival declined to 93% at 6 months, 83% at 12 months, and 65% at 24 months. Development or progression of distant metastases occurred in 40% of patients. Whole-brain radiation therapy was not associated with improved local control. CONCLUSION: Resection bed SRS for brain metastases provided excellent local control. The cavity PTV is predictive of tumor control. Because failure usually occurs outside the PTV, inclusion of a judicious 2- to 3-mm margin beyond the area of postoperative enhancement may be prudent.

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