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MO_5_2589 - Stereotactic radiosurgery for hemorrhagic brain metastases from malignant melanoma

Monday, October 22
10:45 AM - 12:15 PM
Location: Innovation Hub, Exhibit Hall 3

Stereotactic radiosurgery for hemorrhagic brain metastases from malignant melanoma
K. Bauer-Nilsen1, A. Chatrath1, H. Ruiz-Garcia2, E. M. Marchan2, J. L. Peterson3, J. P. Sheehan4, and D. M. Trifiletti2; 1Department of Radiation Oncology, University of Virginia, Charlottesville, VA, 2Department of Radiation Oncology, Mayo Clinic, Jacksonville, FL, 3Department of Neurosurgery, Mayo Clinic, Jacksonville, FL, 4Department of Neurosurgery, University of Virginia, Charlottesville, VA

Purpose/Objective(s): Stereotactic radiosurgery is a common treatment modality among patients with brain metastases, particularly from malignant melanoma. In this study, we investigate the difference in local control, toxicity, and survival among patients with hemorrhagic and solid melanoma brain metastases.

Materials/Methods: We collected demographic, treatment, local control, toxicity and survival data for 134 patients with a total of 936 intracranial melanoma metastases who underwent Gamma Knife stereotactic radiosurgery between 1998-2015 at the University of Virginia Medical Center. Pre-radiosurgical diagnostic imaging was reviewed for evidence of hemorrhage (melanin containing or clearly hemorrhagic).

Results: The population consisted of 92 men and 42 women with a mean age of 61.7 years (range 21.2–84.9) at the time of radiosurgery. Overall survival of patients with brain metastases from malignant melanoma was 42%, 31%, 12% at 12, 24 and 72 months from date of first stereotactic radiosurgery. At 6 months, 43% of the patients with hemorrhagic metastases had local tumor control compared to 83% of solid melanoma metastases (log rank p < 0.001). No significant difference in toxicity was noted between the two groups. Factors that were significantly associated with time to local tumor progression on multivariate analysis include prior WBRT (HR 1.62, p = 0.003), prior chemotherapy (HR 0.69, p = 0.011), margin dose (HR 0.88, p < 0.001) and radiographic features of melanin deposition (HR 3.73, p < 0.001), or clear hemorrhage (HR 2.20, p < 0.001).

Conclusion: Our findings demonstrate that hemorrhagic intracranial melanoma metastases are associated with inferior local tumor control when treated with SRS, as compared to solid tumors. These results highlight the importance of early radiosurgery among patients with melanoma brain metastases before hemorrhage occurs. Among patients with hemorrhagic metastases at diagnosis, neurosurgical resection should be considered in appropriate patients.

Author Disclosure: K. Bauer-Nilsen: None. A. Chatrath: None. H. Ruiz-Garcia: None. E.M. Marchan: None. J.L. Peterson: None. J.P. Sheehan: secretary; N2QOD. D.M. Trifiletti: Member; ARRO.

Kristine Bauer-Nilsen, MD, BS

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