Radiosurgery for melanoma brain metastases in the ipilimumab era and the possibility of longer survival.
Radiosurgery for melanoma brain metastases in the ipilimumab era and the possibility of longer survival.
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DOI：
10.3171/2012.5.jns111929
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发表时间：
2012-08
影响因子：
4.1
通讯作者：
Chiang VL
中科院分区：
文献类型：
--
作者：
Knisely JP;Yu JB;Flanigan J;Sznol M;Kluger HM;Chiang VL
回顾性分析了2002年至2010年期间因黑色素瘤脑转移而接受确定性放射外科手术的77例患者的前瞻性队列，以评估伊匹单抗使用和其他临床变量对生存率的影响。作者进行了一项机构审查委员会批准的病历审查，以评估脑转移诊断时的患者年龄、性别、原发病部位、初始放射外科手术日期、治疗的转移灶数量、体能状态、全身治疗和易普利姆玛病史、全脑放射治疗（WBRT）使用情况、随访持续时间和末次随访时的生存率。根据体能状态和接受治疗的脑转移瘤数量计算每例患者的诊断特异性分级预后评估（DSGPA）评分。35%的患者接受了ipilimumab。该组患者的中位生存期为21.3个月，而未接受ipilimumab治疗的患者为4.9个月。ipilimumab组的2年生存率为47.2%，而nonipilimumab组为19.7%。DS-GPA评分是总生存期最重要的预测因子，易普利姆玛治疗也与死亡风险的改善独立相关（p = 0.03）。用易普利姆玛和确定性放射外科治疗的黑色素瘤脑转移患者的生存期可以超过通常预期的4-6个月。在放射外科治疗脑寡转移瘤的支持性治疗范例中使用伊匹单抗与中位生存期从4.9个月增加到21.3个月相关，2年生存率为19.7%与47.2%。伊匹单抗与生存期延长之间的这种关联即使在调整体能状态后仍然显著，而无需增加挽救性WBRT的需求。
A prospectively collected cohort of 77 patients who underwent definitive radiosurgery between 2002 and 2010 for melanoma brain metastases was retrospectively reviewed to assess the impact of ipilimumab use and other clinical variables on survival. The authors conducted an institutional review board–approved chart review to assess patient age at the time of brain metastasis diagnosis, sex, primary disease location, initial radiosurgery date, number of metastases treated, performance status, systemic therapy and ipilimumab history, whole-brain radiation therapy (WBRT) use, follow-up duration, and survival at the last follow-up. The Diagnosis-Specific Graded Prognostic Assessment (DSGPA) score was calculated for each patient based on performance status and the number of brain metastases treated. Thirty-five percent of the patients received ipilimumab. The median survival in this group was 21.3 months, as compared with 4.9 months in patients who did not receive ipilimumab. The 2-year survival rate was 47.2% in the ipilimumab group compared with 19.7% in the nonipilimumab group. The DS-GPA score was the most significant predictor of overall survival, and ipilimumab therapy was also independently associated with an improvement in the hazard for death (p = 0.03). The survival of patients with melanoma brain metastases managed with ipilimumab and definitive radiosurgery can exceed the commonly anticipated 4–6 months. Using ipilimumab in a supportive treatment paradigm of radiosurgery for brain oligometastases was associated with an increased median survival from 4.9 to 21.3 months, with a 2-year survival rate of 19.7% versus 47.2%. This association between ipilimumab and prolonged survival remains significant even after adjustment for performance status without an increased need for salvage WBRT.