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A Contemporary Report of Clinical Outcomes in Patients with Melanoma Brain Metastases

Background: Brain metastases are observed in more than 40% of all patients with stage 4 melanoma. In recent years, more extensive use of stereotactic radiation (STRT) and the advent of immune checkpoint inhibitors have positively impacted outcomes in patients with metastatic melanoma.brain metastase...

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Autores principales: Phillips, William J., Baghai, Tabassom, Ong, Michael, Lo, Bryan, Ibrahim, Andrea M., Smith, Tyler K. T., Song, Xinni
Formato: Online Artículo Texto
Lenguaje:English
Publicado: MDPI 2021
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7903273/
https://www.ncbi.nlm.nih.gov/pubmed/33450821
http://dx.doi.org/10.3390/curroncol28010045
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author Phillips, William J.
Baghai, Tabassom
Ong, Michael
Lo, Bryan
Ibrahim, Andrea M.
Smith, Tyler K. T.
Song, Xinni
author_facet Phillips, William J.
Baghai, Tabassom
Ong, Michael
Lo, Bryan
Ibrahim, Andrea M.
Smith, Tyler K. T.
Song, Xinni
author_sort Phillips, William J.
collection PubMed
description Background: Brain metastases are observed in more than 40% of all patients with stage 4 melanoma. In recent years, more extensive use of stereotactic radiation (STRT) and the advent of immune checkpoint inhibitors have positively impacted outcomes in patients with metastatic melanoma.brain metastases. Here, we examined real world clinical outcomes of patients presenting with melanoma brain metastases (MBMs). Methods: This retrospective review evaluated MBMs patients treated at The Ottawa Hospital from April 2000 to July 2017. Clinical, radiologic, pathologic and treatment information were gathered from the electronic medical records. The primary outcome was overall survival. The proportional Cox regression model was employed for survival data, while the Fisher’s exact and Mann–Whitney U tests analyzed the relationship between categorical and continuous data, respectively. Results: This retrospective study included 276 patients. Brain metastases were detected symptomatically in 191 patients (69.2%); the rates of detection by routine screening were 4.6% in the pre-2012 era and 11.7% in the contemporary era (p = 0.029). Median survival was three months. Predictors of overall survival were age, higher lactate dehydrogenase (LDH) values, multiple brain lesions, more extensive extracranial disease, neurological symptoms, infratentorial lesions and treatment type. Multivariable analysis demonstrated that stereotactic radiotherapy (STRT) was associated with a hazard ratio of 0.401 (p < 0.001) for survival; likewise, immune checkpoint inhibitor therapy was associated with a hazard ratio of 0.375 (p < 0.001). Conclusion: The findings from this study as “real world” data are consistent with results of pivotal clinical trials in MBMs patients and support contemporary locoregional and immunotherapy practices.
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spelling pubmed-79032732021-02-25 A Contemporary Report of Clinical Outcomes in Patients with Melanoma Brain Metastases Phillips, William J. Baghai, Tabassom Ong, Michael Lo, Bryan Ibrahim, Andrea M. Smith, Tyler K. T. Song, Xinni Curr Oncol Article Background: Brain metastases are observed in more than 40% of all patients with stage 4 melanoma. In recent years, more extensive use of stereotactic radiation (STRT) and the advent of immune checkpoint inhibitors have positively impacted outcomes in patients with metastatic melanoma.brain metastases. Here, we examined real world clinical outcomes of patients presenting with melanoma brain metastases (MBMs). Methods: This retrospective review evaluated MBMs patients treated at The Ottawa Hospital from April 2000 to July 2017. Clinical, radiologic, pathologic and treatment information were gathered from the electronic medical records. The primary outcome was overall survival. The proportional Cox regression model was employed for survival data, while the Fisher’s exact and Mann–Whitney U tests analyzed the relationship between categorical and continuous data, respectively. Results: This retrospective study included 276 patients. Brain metastases were detected symptomatically in 191 patients (69.2%); the rates of detection by routine screening were 4.6% in the pre-2012 era and 11.7% in the contemporary era (p = 0.029). Median survival was three months. Predictors of overall survival were age, higher lactate dehydrogenase (LDH) values, multiple brain lesions, more extensive extracranial disease, neurological symptoms, infratentorial lesions and treatment type. Multivariable analysis demonstrated that stereotactic radiotherapy (STRT) was associated with a hazard ratio of 0.401 (p < 0.001) for survival; likewise, immune checkpoint inhibitor therapy was associated with a hazard ratio of 0.375 (p < 0.001). Conclusion: The findings from this study as “real world” data are consistent with results of pivotal clinical trials in MBMs patients and support contemporary locoregional and immunotherapy practices. MDPI 2021-01-13 /pmc/articles/PMC7903273/ /pubmed/33450821 http://dx.doi.org/10.3390/curroncol28010045 Text en © 2021 by the authors. Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (http://creativecommons.org/licenses/by/4.0/).
spellingShingle Article
Phillips, William J.
Baghai, Tabassom
Ong, Michael
Lo, Bryan
Ibrahim, Andrea M.
Smith, Tyler K. T.
Song, Xinni
A Contemporary Report of Clinical Outcomes in Patients with Melanoma Brain Metastases
title A Contemporary Report of Clinical Outcomes in Patients with Melanoma Brain Metastases
title_full A Contemporary Report of Clinical Outcomes in Patients with Melanoma Brain Metastases
title_fullStr A Contemporary Report of Clinical Outcomes in Patients with Melanoma Brain Metastases
title_full_unstemmed A Contemporary Report of Clinical Outcomes in Patients with Melanoma Brain Metastases
title_short A Contemporary Report of Clinical Outcomes in Patients with Melanoma Brain Metastases
title_sort contemporary report of clinical outcomes in patients with melanoma brain metastases
topic Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7903273/
https://www.ncbi.nlm.nih.gov/pubmed/33450821
http://dx.doi.org/10.3390/curroncol28010045
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