LINAC-based stereotactic radiosurgery to the brain with concurrent vemurafenib for melanoma metastases
LINAC-based stereotactic radiosurgery to the brain with concurrent vemurafenib for melanoma metastases
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DOI：
10.1007/s11060-014-1685-x
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发表时间：
2015-03-01
影响因子：
3.9
通讯作者：
Rao, Nikhil G.
中科院分区：
文献类型：
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作者：
Ahmed, Kamran A.;Freilich, Jessica M.;Rao, Nikhil G.
虽然选择性BRAF抑制剂已证明在转移性BRAF V600E突变型黑色素瘤患者中改善了结局，但治疗前和治疗期间的脑转移管理存在挑战。立体定向放射外科（SRS）是黑色素瘤脑转移瘤的有效治疗方法，但在BRAF治疗期间使用SRS的安全性和有效性数据有限。对在维罗非尼治疗期间接受SRS治疗的转移性黑色素瘤和脑转移患者进行了分析。SRS后审查MRI扫描，以评价局部控制（LC）以及远端控制。我们确定了24例患者中的80处转移性黑色素瘤脑病变。中位计划靶体积为0.28 cm（3）（范围0.05 - 4.19 cm（3）），病变治疗的中位剂量为24戈伊（范围15 - 24戈伊）。中位随访时间为5.1个月（范围2 - 25.2个月）。8处（10%）病变在SRS后中位6.1个月（范围2 - 20.1个月）时显示进展。6个月和12个月时的Kaplan-MeierLC估计值分别为92%和75%。在SRS治疗后中位3.4个月（范围1.9 - 16.1个月）时，观察到14例（58%）患者发生远端脑衰竭。自SRS日期起的中位总体（OS）为7.2个月（范围1.5 - 26.8个月），自脑转移诊断日期起的中位OS为11.9个月（范围1.5 - 28.5个月）。没有证据表明SRS和维罗非尼联合用药会增加毒性。对于同时接受BRAF抑制剂治疗的患者，SRS治疗脑转移似乎安全有效。
While selective BRAF inhibitors have demonstrated improved outcomes in patients with metastatic BRAF V600E mutant melanoma, management of brain metastases prior to and during therapy presents challenges. Stereotactic radiosurgery (SRS) is an effective treatment for melanoma brain metastases, but there is limited safety and efficacy data on the use of SRS during BRAF therapy. An analysis was performed of patients with metastatic melanoma and brain metastases treated with SRS while on vemurafenib. MRI scans were reviewed post-SRS to evaluate local control (LC) as well as distant control. We identified 80 metastatic melanoma brain lesions treated in 24 patients. The median planning target volume was 0.28 cm(3) (range 0.05-4.19 cm(3)), and lesions were treated to a median dose of 24 Gy (range 15-24 Gy). The median follow up was 5.1 months (range 2-25.2 months). Eight (10 %) lesions showed progression at a median of 6.1 months (range 2-20.1 months) following SRS. Kaplan-MeierLC estimates at 6 and 12 months were 92 and 75 %, respectively. Fourteen (58 %) patients were noted to have distant brain failure at a median of 3.4 months (range 1.9-16.1 months) following treatment with SRS. Median overall (OS) from the date of SRS was 7.2 months (range 1.5-26.8 months) with a median of 11.9 months (range 1.5-28.5 months) since the date of brain metastases diagnosis. There was no evidence of increased toxicity with the combination of SRS and vemurafenib. SRS to brain metastases appears to be both safe and effective for patients treated concurrently with BRAF inhibitors.