title: LINAC-based stereotactic radiosurgery to the brain with concurrent vemurafenib for melanoma metastases.
abstract: 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-Meier LC 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.
authors.affiliation: Department of Radiation Oncology, H. Lee Moffitt Cancer Center and Research Institute, 12902 Magnolia Dr., Tampa, FL, 33612, USA, kamran.ahmed@moffitt.org.
authors.forename: Kamran A
authors.initials: KA
authors.lastname: Ahmed
authors.forename: Jessica M
authors.initials: JM
authors.lastname: Freilich
authors.forename: Sarah
authors.initials: S
authors.lastname: Sloot
authors.forename: Nicholas
authors.initials: N
authors.lastname: Figura
authors.forename: Geoffrey T
authors.initials: GT
authors.lastname: Gibney
authors.forename: Jeffrey S
authors.initials: JS
authors.lastname: Weber
authors.forename: Siriporn
authors.initials: S
authors.lastname: Sarangkasiri
authors.forename: Prakash
authors.initials: P
authors.lastname: Chinnaiyan
authors.forename: Peter A
authors.initials: PA
authors.lastname: Forsyth
authors.forename: Arnold B
authors.initials: AB
authors.lastname: Etame
authors.forename: Nikhil G
authors.initials: NG
authors.lastname: Rao
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001921:Brain / Q000473:pathology; D001932:Brain Neoplasms / Q000401:mortality / Q000556:secondary / Q000628:therapy*; D016022:Case-Control Studies; D003131:Combined Modality Therapy; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007211:Indoles / Q000627:therapeutic use*; D008297:Male; D008545:Melanoma / Q000401:mortality / Q000473:pathology / Q000628:therapy*; D008875:Middle Aged; D009367:Neoplasm Staging; D010315:Particle Accelerators; D011379:Prognosis; D016634:Radiosurgery; D013449:Sulfonamides / Q000627:therapeutic use*; D015996:Survival Rate; D000077484:Vemurafenib; D055815:Young Adult
chemical_list: D007211:Indoles; D013449:Sulfonamides; D000077484:Vemurafenib