The role of stereotactic radiotherapy in addition to immunotherapy in the management of melanoma brain metastases: results of a systematic review

Valentina Lancellotta; Laura Del Regno; Alessandro Di Stefani; Bruno Fionda; Fabio Marazzi; Ernesto Rossi; Mario Balducci; Riccardo Pampena; Alessio Giuseppe Morganti; Monica Mangoni; Celeste Lebbe; Claus Garbe; Caterina Longo; Giovanni Schinzari; Luca Tagliaferri; Ketty Peris

doi:10.1007/s11547-022-01503-7

The role of stereotactic radiotherapy in addition to immunotherapy in the management of melanoma brain metastases: results of a systematic review

Radiol Med. 2022 Jul;127(7):773-783. doi: 10.1007/s11547-022-01503-7. Epub 2022 May 23.

Authors

Valentina Lancellotta¹, Laura Del Regno², Alessandro Di Stefani^{2

3}, Bruno Fionda¹, Fabio Marazzi¹, Ernesto Rossi⁴, Mario Balducci¹, Riccardo Pampena^{5

6}, Alessio Giuseppe Morganti^{6

7}, Monica Mangoni⁸, Celeste Lebbe⁹, Claus Garbe¹⁰, Caterina Longo^{5

6}, Giovanni Schinzari⁴, Luca Tagliaferri¹¹, Ketty Peris^{2

3}

Affiliations

¹ UOC Radioterapia Oncologica, Dipartimento di Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, Fondazione Policlinico Universitario "A. Gemelli" IRCCS, Rome, Italy.
² Institute of Dermatology, Catholic University, Rome, Italy.
³ Fondazione Policlinico Universitario A. Gemelli, IRCCS, Rome, Italy.
⁴ Medical Oncology, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy.
⁵ Centro Oncologico ad Alta Tecnologia Diagnostica, Azienda Unità Sanitaria Locale-Istituto di Ricovero e Cura a Carattere Scientifico di Reggio Emilia, Department of Dermatology, University of Modena and Reggio Emilia, Modena, Italy.
⁶ Radiotherapy Center, Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy.
⁷ DIMES, Alma Mater Studiorum University of Bologna, Bologna, Italy.
⁸ Radiation Oncology Unit, Azienda Ospedaliera Universitaria Careggi, University of Florence, Florence, Italy.
⁹ Université de Paris, AP-HP Dermatology, INSERM U976, Saint Louis Hospital, Paris, France.
¹⁰ Institut Gustave Roussy and Paris-Sud-Paris-Saclay University, Villejuif (C.R.), Aix-Marseille University, Marseille (J.J.G.), and Assistance Publique-Hôpitaux de Paris Dermatology and Clinical Investigation Center, Unité 976, Université de Paris, Hôpital Saint-Louis, Paris, France.
¹¹ UOC Radioterapia Oncologica, Dipartimento di Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, Fondazione Policlinico Universitario "A. Gemelli" IRCCS, Rome, Italy. luca.tagliaferri@policlinicogemelli.it.

Abstract

Aim of this study was to systematically review the literature to assess efficacy and safety of stereotactic radiotherapy (SRT) in combination with immunotherapy for the treatment of melanoma brain metastases (MBM). The literature was searched using PubMed, Scopus, and Embase. Studies comparing SRT plus immunotherapy versus SRT or immunotherapy alone were deemed eligible for inclusion. Two studies showed improved overall survival after SRT plus immunotherapy in melanoma cancer patients with brain metastases. Three studies reported data on LC and DFS showing as SRT plus immunotherapy did not improve local control and DFS rates. G3-G4 toxicity was reported in only one study (20% in the SRT plus immunotherapy group versus 23% in the immunotherapy group). Despite SRT plus concurrent immunotherapy seems associated with possible survival advantage and low ≥ G3 late toxicity rates, the quality of evidence is very low. Therefore, in patients with brain metastases from melanoma, SRT plus immunotherapy should be evaluated on an individual basis after discussion by a multidisciplinary team.

Keywords: Brain metastases; Immunotherapy; Overall survival; Stereotactic radiotherapy; Toxicity.

Publication types

Review
Systematic Review

MeSH terms

Brain Neoplasms* / radiotherapy
Brain Neoplasms* / secondary
Humans
Immunotherapy / adverse effects
Immunotherapy / methods
Melanoma* / therapy
Radiosurgery* / methods
Retrospective Studies