Stereotactic radiosurgery and ipilimumab for patients with melanoma brain metastases: clinical outcomes and toxicity
Stereotactic radiosurgery and ipilimumab for patients with melanoma brain metastases: clinical outcomes and toxicity
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DOI：
10.1007/s11060-018-2880-y
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发表时间：
2018-09-01
影响因子：
3.9
通讯作者：
Chang, Eric L.
中科院分区：
文献类型：
--
作者：
Diao, Kevin;Bian, Shelly X.;Chang, Eric L.
有证据表明，ipilimumab和立体定向放射外科（SRS）联合治疗脑转移瘤可改善结局。我们研究了SRS治疗黑色素瘤脑转移患者的临床结局、放射毒性和伊匹单抗时机的影响。我们回顾性地确定了2006年至2015年在我们机构接受SRS治疗的91例黑色素瘤脑转移患者。合并伊匹单抗给药定义为SRS手术+/- 4周内。根据CTCAE v4.03对急性和晚期毒性进行分级。采用Kaplan-Meier方法分析总生存期（OS）、局部衰竭、远端脑衰竭和无衰竭生存期。采用考克斯回归分析OS，23例患者接受ipilimumab联合SRS治疗，28例患者不接受ipilimumab治疗，40例患者未接受ipilimumab治疗。中位年龄为62岁，91%的KPS ae 80。中位随访时间为7.4个月。接受ipilimumab治疗的患者的中位OS为15.1个月，而未接受ipilimumab治疗的患者为7.8个月（p = 0.02）。在多变量分析中，ipilimumab（p = 0.02）和诊断特异性分级预后评估（p = 0.02）与OS相关。放射性坏死的发生率为5%，大多数事件发生在接受ipilimumab治疗的患者中，即使在调整预后因素后，接受ipilimumab治疗的患者的OS也有所改善。Ipilimumab似乎不会增加急性毒性的风险。然而，大多数放射性坏死事件发生在接受伊匹单抗的患者中。我们的研究结果支持在临床上继续使用SRS和伊匹单抗。
There is evidence that the combination of ipilimumab and stereotactic radiosurgery (SRS) for brain metastases improves outcomes. We investigated clinical outcomes, radiation toxicity, and impact of ipilimumab timing in patients treated with SRS for melanoma brain metastases.We retrospectively identified 91 patients treated with SRS at our institution for melanoma brain metastases from 2006 to 2015. Concurrent ipilimumab administration was defined as within +/- 4 weeks of SRS procedure. Acute and late toxicities were graded with CTCAE v4.03. Overall survival (OS), local failure, distant brain failure, and failure-free survival were analyzed with the Kaplan-Meier method. OS was analyzed with Cox regression.Twenty-three patients received ipilimumab concurrent with SRS, 28 patients non-concurrently, and 40 patients did not receive ipilimumab. The median age was 62 years and 91% had KPS ae 80. The median follow-up time was 7.4 months. Patients who received ipilimumab had a median OS of 15.1 months compared to 7.8 months in patients who did not (p = 0.02). In multivariate analysis, ipilimumab (p = 0.02) and diagnosis-specific graded prognostic assessment (p = 0.02) were associated with OS. There were no differences in intracranial control by ipilimumab administration or timing. The incidence of radiation necrosis was 5%, with most events occurring in patients who received ipilimumab.Patients who received ipilimumab had improved OS even after adjusting for prognostic factors. Ipilimumab did not appear to increase risk for acute toxicity. The majority of radiation necrosis events, however, occurred in patients who received ipilimumab. Our results support the continued use of SRS and ipilimumab as clinically appropriate.