title: Prognostic factors for melanoma brain metastases treated with stereotactic radiosurgery.
abstract: OBJECTIVE Stereotactic radiosurgery (SRS) is routinely used to treat brain metastases from melanoma due to their radioresistant nature. The median survival for these patients is 4-6 months, according to earlier studies. The aim of this study was to evaluate prognostic factors that influence survival in patients with metastatic melanoma to the brain treated with SRS. METHODS This retrospective analysis included all patients with melanoma brain metastases treated with SRS at the University of Southern California between 1994 and 2015. For the entire cohort, the authors performed a multivariable Cox regression analysis with an end point of survival. Covariates included number of lesions, total intracranial tumor volume, age, sex, and treatment date prior to 2005 or 2005 onward. In the subset of patients with > 1 lesion, additional multivariable Cox regression was performed, with covariates of Karnofsky Performance Scale, Graded Prognostic Assessment, Recursive Partitioning Analysis, timing of metastases (synchronous/metachronous), change in lesion number, and previous whole-brain radiation therapy or resection in addition to the previously mentioned covariates. Overall survival (OS) was calculated from the day SRS was performed to the date of last follow-up or date of death. RESULTS A total of 401 patients were available for analysis. The median follow-up was 35.1 months for patients alive at the time of analysis, and the median OS was 7.7 months for the entire cohort (95% CI 6.7-8.3 months). In the entire cohort, greater number of brain lesions, higher total intracranial tumor volume, age > 50 years, treatment prior to 2005, and male sex were found to be statistically significant factors associated with worse survival. The strongest risk factors for decreased OS were tumor volume > 10 cm3and ≥ 5 lesions, with hazard ratios for risk of death of 1.7 and 2.2, respectively. In the subset of patients with > 1 lesion, tumor volume > 10 cm3and no resection were the only factors significantly associated with decreased OS, with hazard ratios of 1.9 and 2.0 (hazard ratio of 0.49 for resection), respectively. CONCLUSIONS This study suggests that greater lesion number, higher intracranial tumor volume, older age, treatment prior to 2005, and male sex have prognostic significance for decreased OS in patients with melanoma brain metastases treated with SRS. Additionally, in the subset of patients with > 1 lesion, only higher total tumor volume and no resection were associated with worse survival.
authors.affiliation: Departments of 1 Radiation Oncology.
authors.forename: Shelly X
authors.initials: SX
authors.lastname: Bian
authors.affiliation: Departments of 1 Radiation Oncology.
authors.forename: David
authors.initials: D
authors.lastname: Routman
authors.affiliation: Departments of 1 Radiation Oncology.
authors.forename: Jonathan
authors.initials: J
authors.lastname: Liu
authors.affiliation: Biostatistics, University of Southern California, Keck School of Medicine, Los Angeles, California.
authors.forename: Dongyun
authors.initials: D
authors.lastname: Yang
authors.affiliation: Biostatistics, University of Southern California, Keck School of Medicine, Los Angeles, California.
authors.forename: Susan
authors.initials: S
authors.lastname: Groshen
authors.affiliation: Neurosurgery.
authors.forename: Gabriel
authors.initials: G
authors.lastname: Zada
authors.affiliation: Departments of 1 Radiation Oncology.
authors.forename: Nicholas
authors.initials: N
authors.lastname: Trakul
authors.affiliation: Medical Oncology, and.
authors.forename: Michael K
authors.initials: MK
authors.lastname: Wong
authors.affiliation: Departments of 1 Radiation Oncology.
authors.forename: Cheng
authors.initials: C
authors.lastname: Yu
authors.affiliation: Departments of 1 Radiation Oncology.
authors.forename: Eric L
authors.initials: EL
authors.lastname: Chang
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001932:Brain Neoplasms / Q000401:mortality* / Q000532:radiotherapy* / Q000556:secondary; D005260:Female; D006801:Humans; D008297:Male; D008545:Melanoma / Q000401:mortality* / Q000532:radiotherapy* / Q000556:secondary; D008875:Middle Aged; D011379:Prognosis; D016634:Radiosurgery; D012189:Retrospective Studies; D015996:Survival Rate; D055815:Young Adult
keywords: GPA = graded prognostic assessment; HR = hazard ratio; KPS = Karnofsky Performance Scale; OS = overall survival; RPA = recursive partitioning analysis; SRS = stereotactic radiosurgery; WBRT = whole-brain radiation therapy; brain; melanoma; metastases; oncology; prognostic; radiation; stereotactic radiosurgery