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Stereotactic radiosurgery combined with anti-PD1 for the management of melanoma brain metastases: A retrospective study of safety and efficacy.

立体定向放射外科联合 anti-PD1 治疗黑色素瘤脑转移: 安全性和有效性的回顾性研究。

  • 影响因子:6.15
  • DOI:10.1016/j.ejca.2020.04.028
  • 作者列表:"Carron R","Gaudy-Marqueste C","Amatore F","Padovani L","Malissen N","Balossier A","Loundou A","Bonnet N","Muracciole X","Régis JM","Grob JJ
  • 发表时间:2020-06-11
Abstract

BACKGROUND:Brain metastases can be effectively treated with stereotactic radiosurgery (SRS). Immune checkpoint inhibitors are now pivotal in metastatic melanoma care, but some concerns have emerged regarding the safety of their combination with radiation therapy. METHODS:We present a retrospective analysis of a cohort of patients treated by anti-PD1 and SRS as a sole modality of radiation therapy (no whole brain radiation therapy at any time) in a single institution. We included patients on anti-PD1 at the time of SRS or patients who started anti-PD1 within a maximum period of 3 months following SRS and were treated at least one year before the analysis. Clinical and serial imaging data were reviewed to determine the efficacy and the rate of adverse radiation effectss of the combination. RESULTS:A total of 50 patients were included. SRS targeted 1, 2 to 3 and >3 brain metastases in 17, 16 and 17 patients, respectively. Two patients died before the first evaluation. Nine patients presented with an increase in peritumoral oedema, three with intracranial haemorrhage and one patient with both oedema and haemorrhage. Median follow-up was 38.89 months (interquartile range 24.43; 45.28). Median overall survival from SRS was 16.62 months with 1-, 2- and 3-year rates of 60%, 40% and 35%, respectively. Median brain-Progression Free Survival was 13.2 months with 1, 2 and 3-year rates of 62.1%, 49.7% and 49.7%, respectively. CONCLUSIONS:This real-world cohort of patients treated with a homogeneous strategy combining upfront stereotactic radiosurgery and anti-PD1 shows remarkable survival rates and does not reveal unexpected toxicity.

摘要

背景: 立体定向放射外科 (SRS) 可有效治疗脑转移瘤。免疫检查点抑制剂现在是转移性黑色素瘤治疗的关键,但是关于它们与放射治疗联合使用的安全性已经出现了一些担忧。 方法: 我们对在单个机构接受 anti-PD1 和 SRS 治疗的患者队列进行回顾性分析,作为放射治疗的唯一方式 (任何时候都没有全脑放射治疗)。我们纳入了 SRS 时 anti-PD1 的患者或 SRS 后最长 3 个月内开始 anti-PD1 并在分析前至少 1 年接受治疗的患者。回顾临床和系列影像学数据,以确定联合用药的疗效和不良辐射效应率。 结果: 共纳入 50 例患者。SRS 分别针对 17 、 16 和 17 例患者的 1 、 2 至 3 和> 3 个脑转移灶。2 例患者在首次评估前死亡。9 例患者瘤周水肿增加,3 例颅内出血,1 例同时水肿和出血。中位随访时间为 38.89 个月 (四分位数间距 24.43; 45.28)。SRS 的中位总生存期为 16.62 个月,1 、 2 和 3 年率分别为 60% 、 40% 和 35%。中位脑无进展生存期为 13.2 个月,1 、 2 和 3 年率分别为 62.1% 、 49.7% 和 49.7%。 结论: 这个真实世界的患者队列采用了前期立体定向放射外科和 anti-PD1 相结合的同质策略,显示了显著的生存率,并没有发现意想不到的毒性。

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