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Radiosurgery fractionation and post-treatment hemorrhage development for intact melanoma brain metastases

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Abstract

Purpose

To assess, for intact melanoma brain metastases (MBM), whether single-fraction stereotactic radiosurgery (SRS) versus fractionated stereotactic radiotherapy (fSRT) is associated with a differential risk of post-treatment lesion hemorrhage (HA) development.

Methods

A single institution retrospective database review identified consecutive patients with previously unresected MBM treated with robotic SRS/fSRT between 2013 and 2021. The presence of lesion HA was determined by multi-disciplinary imaging review. Dosimetric variables were reported as biologically effective doses using an α/β ratio of 2.5 (BED2.5). Statistical analysis was performed using mixed effect logistic regression for post-treatment HA and Cox frailty modeling for local control (LC).

Results

The cohort included 48 patients with 226 intact MBM treated with SRS/fSRT. Of lesions without prior HA, 63 of 133 lesions (47.4%) receiving SRS demonstrated evidence of post-treatment HA versus 2 of 24 lesions (8.3%) treated with fSRT (p = 0.01). A larger maximum BED2.5 was observed in lesions developing HA compared to no HA (238.3 Gy vs. 211.4 Gy; p = 0.022). 12-month LC was 65.7% (95% CI 37.2–87.3%) and 77.5% (95% CI 58.5–91.2%) for lesions demonstrating pre-treatment and post-treatment HA, respectively, with no local failure events observed within 12 months for non-hemorrhagic lesions (p < 0.001).

Conclusion

We found an increased incidence of post-treatment HA for intact MBM receiving a larger maximum BED2.5, which was significantly higher for single fraction treatments within our cohort. The presence of lesion HA, either pre- or post-treatment, was indicative of inferior LC. Further investigations of optimal dose and fractionation schedules for treatment of MBM in the era of immunotherapy are warranted.

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Data Availability

The datasets generated during and/or analyzed during the current study are available from the corresponding author on reasonable request.

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Funding

The authors declare that no funds, grants, or other support were received during the preparation of this manuscript. This research study was conducted retrospectively from data obtained for clinical purposes. This study was determined to be exempted by the University of Louisville Institutional Review Board (IRB #21.0039).

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Authors and Affiliations

  1. Department of Radiation Oncology, Brown Cancer Center, University of Louisville School of Medicine, 529 S Jackson St, Louisville, KY, 40202, USA

    Grant McKenzie & Shiao Woo

  2. Department of Bioinformatics and Biostatistics, School of Public Health and Information Science, University of Louisville, 485 E. Gray St, Louisville, KY, 40202, USA

    Jeremy Gaskins

  3. Department of Radiation Oncology, Tufts University Medical Center, 800 Washington St, Boston, MA, 02111, USA

    Abbas Rattani

  4. School of Medicine, University of Louisville, 500 S Preston St, Louisville, KY, 40202, USA

    Alexandria Oliver, William Southall & Fumihiko Nakamura

  5. Department of Radiation Oncology, O’Neal Comprehensive Cancer Center, School of Medicine, University of Alabama at Birmingham, 1824 6th Ave S, Birmingham, AL, 35233, USA

    Mehran Yusuf

  6. Department of Neurosurgery, University of Louisville Hospital, 530 S Jackson St, Louisville, KY, 40202, USA

    Akshitkumar Mistry & Brian Williams

Authors
  1. Grant McKenzie
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Contributions

All authors contributed to the study conception and design. Material preparation, data collection and analysis were performed by GM, JG, WS, FN, and AO. The first draft of the manuscript was written by GM and all authors commented on previous versions of the manuscript. All authors read and approved the final manuscript.

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Correspondence to Grant McKenzie.

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McKenzie, G., Gaskins, J., Rattani, A. et al. Radiosurgery fractionation and post-treatment hemorrhage development for intact melanoma brain metastases. J Neurooncol 160, 591–599 (2022). https://doi.org/10.1007/s11060-022-04178-2

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  • DOI: https://doi.org/10.1007/s11060-022-04178-2

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