Mariya Yavorska, Miriam Tomiciello, Sciurti Antonio, Elisa Cinelli, Giovanni Rubino, Armando Perrella, Alfonso Cerase, Pierpaolo Pastina, Giovanni Luca Gravina, Silvia Arcieri, Maria Antonietta Mazzei, Giuseppe Migliara, Valentina Baccolini, Francesco Marampon, Giuseppe Minniti, Anna Maria Di Giacomo, Paolo Tini
{"title":"黑色素瘤脑转移灶周围水肿体积对立体定向放射手术反应的预测价值","authors":"Mariya Yavorska, Miriam Tomiciello, Sciurti Antonio, Elisa Cinelli, Giovanni Rubino, Armando Perrella, Alfonso Cerase, Pierpaolo Pastina, Giovanni Luca Gravina, Silvia Arcieri, Maria Antonietta Mazzei, Giuseppe Migliara, Valentina Baccolini, Francesco Marampon, Giuseppe Minniti, Anna Maria Di Giacomo, Paolo Tini","doi":"10.1007/s11060-024-04818-9","DOIUrl":null,"url":null,"abstract":"<h3 data-test=\"abstract-sub-heading\">Background and aim</h3><p>Stereotactic radiotherapy (SRT) is an established treatment for melanoma brain metastases (MBM). Recent evidence suggests that perilesional edema volume (PEV) might compromise the delivery and efficacy of radiotherapy to treat BM. This study investigated the association between SRT efficacy and PEV extent in MBM.</p><h3 data-test=\"abstract-sub-heading\">Materials and methods</h3><p>This retrospective study reviewed medical records from January 2020 to September 2023. Patients with up to 5 measurable MBMs, intracranial disease per RANO/iRANO criteria, and on low-dose corticosteroids were included. MRI scans assessed baseline neuroimaging, with PEV analyzed using 3D Slicer. SRT plans were based on MRI-CT fusion, delivering 18–32.5 Gy in 1–5 fractions. Outcomes included intracranial objective response rate (iORR) and survival measures (L-iPFS and OS). Statistical analysis involved decision tree analysis and multivariable logistic regression, adjusting for clinical and treatment variables.</p><h3 data-test=\"abstract-sub-heading\">Results</h3><p>Seventy-two patients with 101 MBM were analyzed, with a mean age of 68.83 years. The iORR was 61.4%, with Complete Response (CR) in 21.8% and Partial Response (PR) in 39.6% of the treated lesions. PEV correlated with KPS, BRAF status, and treatment response. Decision tree analysis identified a PEV cutoff at 0.5 cc, with lower PEVs predicting better responses (AUC = 0.82 sensitivity: 86.7%, specificity:74.4%,). Patients with PEV ≥ 0.5 cc had lower response rates (iORR 44.7% vs. 63.8%, <i>p</i> < 0.001). Median OS was 9.4 months, with L-iPFS of 27 months. PEV significantly impacted survival outcomes.</p><h3 data-test=\"abstract-sub-heading\">Conclusions</h3><p>A more extensive PEV was associated with a less favorable outcome to SRT in MBM.</p>","PeriodicalId":16425,"journal":{"name":"Journal of Neuro-Oncology","volume":null,"pages":null},"PeriodicalIF":3.2000,"publicationDate":"2024-09-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":"{\"title\":\"Predictive value of perilesional edema volume in melanoma brain metastasis response to stereotactic radiosurgery\",\"authors\":\"Mariya Yavorska, Miriam Tomiciello, Sciurti Antonio, Elisa Cinelli, Giovanni Rubino, Armando Perrella, Alfonso Cerase, Pierpaolo Pastina, Giovanni Luca Gravina, Silvia Arcieri, Maria Antonietta Mazzei, Giuseppe Migliara, Valentina Baccolini, Francesco Marampon, Giuseppe Minniti, Anna Maria Di Giacomo, Paolo Tini\",\"doi\":\"10.1007/s11060-024-04818-9\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<h3 data-test=\\\"abstract-sub-heading\\\">Background and aim</h3><p>Stereotactic radiotherapy (SRT) is an established treatment for melanoma brain metastases (MBM). Recent evidence suggests that perilesional edema volume (PEV) might compromise the delivery and efficacy of radiotherapy to treat BM. This study investigated the association between SRT efficacy and PEV extent in MBM.</p><h3 data-test=\\\"abstract-sub-heading\\\">Materials and methods</h3><p>This retrospective study reviewed medical records from January 2020 to September 2023. Patients with up to 5 measurable MBMs, intracranial disease per RANO/iRANO criteria, and on low-dose corticosteroids were included. MRI scans assessed baseline neuroimaging, with PEV analyzed using 3D Slicer. SRT plans were based on MRI-CT fusion, delivering 18–32.5 Gy in 1–5 fractions. Outcomes included intracranial objective response rate (iORR) and survival measures (L-iPFS and OS). Statistical analysis involved decision tree analysis and multivariable logistic regression, adjusting for clinical and treatment variables.</p><h3 data-test=\\\"abstract-sub-heading\\\">Results</h3><p>Seventy-two patients with 101 MBM were analyzed, with a mean age of 68.83 years. The iORR was 61.4%, with Complete Response (CR) in 21.8% and Partial Response (PR) in 39.6% of the treated lesions. PEV correlated with KPS, BRAF status, and treatment response. Decision tree analysis identified a PEV cutoff at 0.5 cc, with lower PEVs predicting better responses (AUC = 0.82 sensitivity: 86.7%, specificity:74.4%,). Patients with PEV ≥ 0.5 cc had lower response rates (iORR 44.7% vs. 63.8%, <i>p</i> < 0.001). Median OS was 9.4 months, with L-iPFS of 27 months. 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Predictive value of perilesional edema volume in melanoma brain metastasis response to stereotactic radiosurgery
Background and aim
Stereotactic radiotherapy (SRT) is an established treatment for melanoma brain metastases (MBM). Recent evidence suggests that perilesional edema volume (PEV) might compromise the delivery and efficacy of radiotherapy to treat BM. This study investigated the association between SRT efficacy and PEV extent in MBM.
Materials and methods
This retrospective study reviewed medical records from January 2020 to September 2023. Patients with up to 5 measurable MBMs, intracranial disease per RANO/iRANO criteria, and on low-dose corticosteroids were included. MRI scans assessed baseline neuroimaging, with PEV analyzed using 3D Slicer. SRT plans were based on MRI-CT fusion, delivering 18–32.5 Gy in 1–5 fractions. Outcomes included intracranial objective response rate (iORR) and survival measures (L-iPFS and OS). Statistical analysis involved decision tree analysis and multivariable logistic regression, adjusting for clinical and treatment variables.
Results
Seventy-two patients with 101 MBM were analyzed, with a mean age of 68.83 years. The iORR was 61.4%, with Complete Response (CR) in 21.8% and Partial Response (PR) in 39.6% of the treated lesions. PEV correlated with KPS, BRAF status, and treatment response. Decision tree analysis identified a PEV cutoff at 0.5 cc, with lower PEVs predicting better responses (AUC = 0.82 sensitivity: 86.7%, specificity:74.4%,). Patients with PEV ≥ 0.5 cc had lower response rates (iORR 44.7% vs. 63.8%, p < 0.001). Median OS was 9.4 months, with L-iPFS of 27 months. PEV significantly impacted survival outcomes.
Conclusions
A more extensive PEV was associated with a less favorable outcome to SRT in MBM.
期刊介绍：
The Journal of Neuro-Oncology is a multi-disciplinary journal encompassing basic, applied, and clinical investigations in all research areas as they relate to cancer and the central nervous system. It provides a single forum for communication among neurologists, neurosurgeons, radiotherapists, medical oncologists, neuropathologists, neurodiagnosticians, and laboratory-based oncologists conducting relevant research. The Journal of Neuro-Oncology does not seek to isolate the field, but rather to focus the efforts of many disciplines in one publication through a format which pulls together these diverse interests. More than any other field of oncology, cancer of the central nervous system requires multi-disciplinary approaches. To alleviate having to scan dozens of journals of cell biology, pathology, laboratory and clinical endeavours, JNO is a periodical in which current, high-quality, relevant research in all aspects of neuro-oncology may be found.
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