Oral Presentation Clinical Oncology Society of Australia Annual Scientific Meeting 2017

Cranial Radiosurgery and immune therapy. Should we be concerned re toxicity? (#7)

Brindha Shivalingam 1 , Angela Hong 2
  1. Royal Prince Alfred Hospital/Chris O'Brien Lifehouse, Camperdown, NSW, Australia
  2. Melanoma Institute Australia, Sydney, NSW, Australia

In the setting of melanoma, brain metastases may be seen in up to 40% of patients with stage IV disease. An accepted and highly effective local treatment for brain metastases is Stereotactic Radiosurgery (SRS). However, local failure may be seen in up to 25% of lesions treated with SRS, which then necessitates salvage surgery.

In recent years, many patients with stage IV melanoma also received immunotherapy along with SRS. The development of brain radiation necrosis (BRN) has become a challenging entity in terms of both diagnosis and management.

To date there are few studies attempting to define predictors for the occurrence of BRN. Therefore we retrospectively reviewed 38 consecutive patients who had salvage surgery for progression post SRS with the aim of defining tumour and/or treatment factors that may be associated with an increased risk of BRN. Included in this cohort are 3 patients who developed severe, symptomatic BRN.

We present the findings of this study.

Conclusion : Whilst most patients with BRN may be managed with surgical resection, high dose steroids and/or bevacizumab with minimal morbidity, a select few will suffer significant, debilitating neurotoxicity.