title: Radiotherapy utilization in BRAF mutation-tested metastatic melanoma in the targeted therapy era.
abstract: OBJECTIVE
  Tumor BRAF mutation testing is routine for all patients with metastatic melanoma (MM) owing to the availability of agents targeting this intracellular pathway. To test whether there is a difference in radiotherapy (RT) utilization according to BRAF mutation status, we performed a retrospective review of RT utilization in a contemporary cohort undergoing BRAF mutation testing.
  
  
  METHODS
  Clinical records of MM patients undergoing BRAF mutation testing between April 2010 and August 2012 were reviewed. Overall survival (OS) was calculated using Kaplan-Meier methods. Differences between BRAF status were calculated using chi-square tests for categorical variables, median tests for continuous variables and Cox proportional hazards models to compare OS.
  
  
  RESULTS
  Up to 158 patients were identified but 17 were excluded due to inadequate clinical data. Of the remaining 141 patients, 69 (49%) tested BRAF mutant (BRAF-m), median age 47 years (range 21-79) with median follow-up of 16.8 months (IQR11.3-25.2). Seventy-two (51%) tested BRAF wild type (BRAF-w), median age 62 years (range 25-84) with median follow-up of 27.1 months (IQR12.5-57.4). Overall, RT utilization was similar: 68% in BRAF-m and 69% in BRAF-w. Mean number of treatment courses was 1.70 for BRAF-m and 2.36 for BRAF-w (Pearson chi-square 3.92, P = 0.05). Up to 51% of BRAF-m and 56% of BRAF-w required ≧2 RT courses. Forty-six percent BRAF-m compared with 29% BRAF-w received brain RT (P = 0.04). Median OS was 17.7 months (IQR7.6-35.5) in BRAF-m and 19 months (IQR7.8-35.1) in BRAF-w (P = 0.99).
  
  
  CONCLUSIONS
  High RT utilization rates were observed irrespective of BRAF mutation status. Significantly more BRAF-w patients received RT but more BRAF-m patients received brain RT.
authors: Department of Radiation Oncology, Princess Alexandra Hospital, Woolloongabba, Queensland, Australia.
authors: Peter
authors: P
authors: Gorayski
authors: Department of Medical Oncology, Princess Alexandra Hospital, Woolloongabba, Queensland, Australia.|Diamantina Institute, University of Queensland, Brisbane, Queensland, Australia.
authors: Marcin
authors: M
authors: Dzienis
authors: Department of Radiation Oncology, Princess Alexandra Hospital, Woolloongabba, Queensland, Australia.|Diamantina Institute, University of Queensland, Brisbane, Queensland, Australia.
authors: Matthew
authors: M
authors: Foote
authors: Department of Medical Oncology, Princess Alexandra Hospital, Woolloongabba, Queensland, Australia.
authors: Victoria
authors: V
authors: Atkinson
authors: Nursing Practice Development Unit, Princess Alexandra Hospital & Centre for Health Practice Innovation, Griffith University, Brisbane, Queensland, Australia.
authors: Elizabeth
authors: E
authors: Burmeister
authors: Department of Radiation Oncology, Princess Alexandra Hospital, Woolloongabba, Queensland, Australia.
authors: Bryan
authors: B
authors: Burmeister
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015331:Cohort Studies; D005260:Female; D006801:Humans; D008297:Male; D008545:Melanoma / Q000473:pathology / Q000532:radiotherapy*; D008875:Middle Aged; D009154:Mutation; D048493:Proto-Oncogene Proteins B-raf / Q000235:genetics* / Q000528:radiation effects; D012189:Retrospective Studies; D016896:Treatment Outcome; D055815:Young Adult
chemical_list: C482119:BRAF protein, human; D048493:Proto-Oncogene Proteins B-raf
keywords: BRAF; melanoma; radiotherapy; utilization