Factors Associated with Hemorrhage of Melanoma Brain Metastases after Stereotactic Radiosurgery in the Era of Targeted/Immune Checkpoint Inhibitor Therapies
Abstract
:Simple Summary
Abstract
1. Introduction
2. Materials and Methods
2.1. SRS Treatment Planning
2.2. Follow-Up and Statistical Analysis
3. Results
3.1. Patients and Administration of Systemic Therapy
3.2. Hemorrhage
3.3. Logistic Regression Model
4. Discussion
5. Conclusions
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Conflicts of Interest
References
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Characteristic | N = 55 n (%) |
---|---|
Primary tumor known | 41 (74.5) |
Cancer of unknown primary | 14 (25.5) |
Specific mutations | |
BRAF | 22 (40) |
NRAS | 10 (18.1) |
cKIT | 1 (1.8) |
Brain metastases | |
Synchronous | 14 (25.5) |
Metachronous | 41 (74.5) |
Number of irradiated brain metastases pro SRS | |
Median | 2 |
Range | 1–20 |
Volume of the irradiated brain metastases pro SRS | |
Median | 1.47 |
Range | 0.08–7.8 |
Number of irradiated metastases receiving one SRS fraction | 263 |
Number of irradiated metastases receiving two SRS fractions | 16 |
Characteristic | Median (Range) |
---|---|
Dose | 20 (16–20) |
Isodose | 64 (59–75) |
Dose max | 29.9 (23.5–33.9) |
Dose mean | 24.1 (19.1–27.6) |
Conformity index | 1.15 (1.02–2.44) |
Homogeneity Index | 1.56 (1.17–1.69) |
Coverage | 95.5 (95.5–100) |
Systemic Therapy | SRS Fractions n = 93 (%) |
---|---|
Immune checkpoint inhibitor | 63 (67.7) |
Targeted therapies | 20 (21.5) |
Dacarbazine | 2 (2.2) |
Interferon | 2 (2.2) |
No systemic therapy | 6 (6.4) |
Immune checkpoint inhibitor | |
Nivolumab | 19 |
Pembrolizumab | 19 |
Ipilimumab | 10 |
Ipilimumab/Nivolumab | 15 |
Targeted therapy | |
Dabrafenib/Trametinib | 13 |
Vemurafenib/Cobimetinib | 4 |
Dabrafenib | 2 |
Vemurafenib | 1 |
Administration of immune checkpoint inhibitor either before or after SRS | n = 63 (%) |
Within 7 days | 22 (34.9) |
Within 15 days | 37 (58.7) |
Within 30 days | 47 (74.6) |
Toxicity | N = 25 (%) |
---|---|
Grade 3 | |
Generalized seizure | 4 (16) |
Hemiparesis | 3 (12) |
Ataxia | 2 (8) |
Cognitive disturbance | 1 (4) |
Grade 1 | |
Headache | 4 (16) |
Facial nerve disorder | 1 (4) |
Grade 0 | 10 (40) |
a | |||
---|---|---|---|
Independent Variable | Standard Deviation | p Value | Confidence Interval |
Systemic Therapy within 7 days from SRS | 0.46 | 0.015 | 1.34—16.3 |
Receipt of Anticoagulants by the day of SRS | 0.63 | 0.017 | 1.63—161.7 |
b | |||
Independent Variable | Standard Deviation | pValue | Confidence Interval |
Receipt of Anticoagulants by the day of SRS | 0.95 | 0.01 | 1.77—75.2 |
WBRT before the evidence of hemorrhage | 1.39 | 0.06 | 0.89—209.2 |
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Zoga, E.; Wolff, R.; Ackermann, H.; Meissner, M.; Rödel, C.; Tselis, N.; Chatzikonstantinou, G. Factors Associated with Hemorrhage of Melanoma Brain Metastases after Stereotactic Radiosurgery in the Era of Targeted/Immune Checkpoint Inhibitor Therapies. Cancers 2022, 14, 2391. https://doi.org/10.3390/cancers14102391
Zoga E, Wolff R, Ackermann H, Meissner M, Rödel C, Tselis N, Chatzikonstantinou G. Factors Associated with Hemorrhage of Melanoma Brain Metastases after Stereotactic Radiosurgery in the Era of Targeted/Immune Checkpoint Inhibitor Therapies. Cancers. 2022; 14(10):2391. https://doi.org/10.3390/cancers14102391
Chicago/Turabian StyleZoga, Eleni, Robert Wolff, Hanns Ackermann, Markus Meissner, Claus Rödel, Nikolaos Tselis, and Georgios Chatzikonstantinou. 2022. "Factors Associated with Hemorrhage of Melanoma Brain Metastases after Stereotactic Radiosurgery in the Era of Targeted/Immune Checkpoint Inhibitor Therapies" Cancers 14, no. 10: 2391. https://doi.org/10.3390/cancers14102391
APA StyleZoga, E., Wolff, R., Ackermann, H., Meissner, M., Rödel, C., Tselis, N., & Chatzikonstantinou, G. (2022). Factors Associated with Hemorrhage of Melanoma Brain Metastases after Stereotactic Radiosurgery in the Era of Targeted/Immune Checkpoint Inhibitor Therapies. Cancers, 14(10), 2391. https://doi.org/10.3390/cancers14102391