Central Nervous System
PV QA 2 - Poster Viewing Q&A 2
Purpose/Objective(s): Outcomes for patients with melanoma brain metastasis (MBM) are poor. New radiotherapy techniques and systemic agents have improved outcomes in trials. Outcomes have rarely been studied at the population level. We undertook a population-based study investigating changes in management and outcome for MBM.
Materials/Methods: This was a retrospective cohort study of MBM patients in the Ontario Cancer Registry treated 2007-2016. Treatment, co-variates and outcomes were defined using administrative data. Treatments and outcomes were described by era (2007-2009, 2010-2012, 2013-2016). Outcomes were adjusted using Cox regression.
Results: 1096 MBM patients were treated 2007-2016 (326 in 2007-2009, 310 in 2010-2012, 460 in 2013-2016). Patient factors and time from melanoma diagnosis to the first palliative treatment were similar between eras, though case numbers increased. The first brain-directed treatment (ie surgery, whole brain radiation therapy (WBRT) or conformal RT) was WBRT in 75.5% 2007-2009, dropping to 52.0% 2013-2016. Stereotactic radiation or other conformal techniques increased: 3.4% 2007-2009; 21.3% 2013-2016. Intracranial resection also increased: 21.2% in 2007-2009; 26.7% in 2013-2016. Use of BRAF/MEK inhibitors and/or immunotherapy increased: <2.0% 2007-2009; 40.9% 2013-2016. In 2013-2016, one and two-year overall survival (OS) was 21.8% and 13.8%. This compared to 12.3% and 6.4% 2007-2009, and 10.7% and 5.5% 2010-2012 (p=0.001). In adjusted analysis the OS difference remained (adjusted hazard ratio (AHR) 2013-2016 vs. 2007-2009: 0.65(95% CI 0.56-0.77)). Analysis included adjustment for temporal and regional variation in pre-diagnosis surveillance with brain MRI or CT. In 2007-2009 more WBRT was prescribed (AHR 2013-2016 vs. 2007-2009: 0.32(0.22-0.46)). The time from first to second brain-directed treatment was shorter in later eras (e.g. AHR 2013-2016 vs. 2007-2009: 2.16(1.48-3.14)).
Conclusion: The uptake of new radiotherapy techniques and systemic treatments for MBM was associated with increased survival and less WBRT. The time between brain-directed courses decreased as stereotactic treatments increased. However, many still received WBRT.
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