Radiation therapy for melanoma brain metastases: a systematic review

Abstract

Background Radiation therapy (RT) for melanoma brain metastases, delivered either as whole brain radiation therapy (WBRT) or as stereotactic radiosurgery (SRS), is an established component of treatment for this condition. However, evidence allowing comparison of the outcomes, advantages and disadvantages of the two RT modalities is scant, with very few randomised controlled trials having been conducted. This has led to considerable uncertainty and inconsistent guideline recommendations. The present systematic review identified 112 studies reporting outcomes for patients with melanoma brain metastases treated with RT. Three were randomised controlled trials but only one was of sufficient size to be considered informative. Most of the evidence was from non-randomised studies, either specific treatment series or disease cohorts. Criteria for determining treatment choice were reported in only 32 studies and the quality of these studies was variable. From the time of diagnosis of brain metastasis, the median survival after WBRT alone was 3.5 months (IQR 2.4–4.0 months) and for SRS alone it was 7.5 months (IQR 6.7–9.0 months). Overall patient survival increased over time (pre-1989 to 2015) but this was not apparent within specific treatment groups. Conclusions These survival estimates provide a baseline for determining the incremental benefits of recently introduced systemic treatments using targeted therapy or immunotherapy for melanoma brain metastases.

Demographics aspects of brain and spine metastatic melanoma. Retrospective analysis in a single third-level center

“… 22 According to Thompson et al, their systematic review found a difference of 6 months in survival in patients treated only with surgery versus those treated with radiotherapy alone (10 months versus four months, respectively). 23 Like our findings, the median survival in patients treated with radiotherapy alone was five months, and for patients treated with surgery, it was 13 months for metastatic lesions to the CNS.…”

Local and Systemic Management Options for Melanoma Brain Metastases

“…A recent systematic review analyzed the results of 112 studies that had reported outcomes for patients with MBMs treated with various RT regimens. 26 Although data were mainly derived from nonrandomized studies, limited within-study comparisons showed a trend toward better survival in patients treated with SRS alone (7.5 months) compared with those receiving WBRT alone (3.5 months). This difference may, in part, be attributed to selection biases, as patients with fewer brain lesions and better performance status are more likely to undergo SRS, and these characteristics are associated with more favorable survival outcomes.…”

“…The findings from this study indicated less cognitive decline among patients who received SRS alone. A recent systematic review analyzed the results of 112 studies that had reported outcomes for patients with MBMs treated with various RT regimens 26 . Although data were mainly derived from nonrandomized studies, limited within-study comparisons showed a trend toward better survival in patients treated with SRS alone (7.5 months) compared with those receiving WBRT alone (3.5 months).…”

Immunotherapy Combined with Radiation in Malignant Melanoma without BRAF Mutations Brain Metastases—Favorable Response after Immunotherapy Continued beyond Progression

“…Thompson JF et al, in a systematic review performed in 2022, revealed that from the time of diagnosis of brain metastasis, the median survival after SRS alone was 7.5 months [18].…”