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Jablonska PA, Muniz T, Ribeiro M, Liu ZA, Ye XY, Devaraja K, Laperriere N, Millar BA, Conrad T, Kongkham P, Butler M, Shultz DB. Toxicity and outcomes of melanoma brain metastases treated with stereotactic radiosurgery: the risk of subsequent symptomatic intralesional hemorrhage exceeds that of radiation necrosis. J Neurooncol 2023; 164:199-209. [PMID: 37552363 DOI: 10.1007/s11060-023-04404-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2023] [Accepted: 07/19/2023] [Indexed: 08/09/2023]
Abstract
PURPOSE We aimed to assess the outcomes and patterns of toxicity in patients with melanoma brain metastases (MBM) treated with stereotactic radiosurgery (SRS) with or without immunotherapy (IO). METHODS From a prospective registry, we reviewed MBM patients treated with single fraction Gamma Knife SRS between 2008 and 2021 at our center. We recorded all systemic therapies (chemotherapy, targeted therapy, or immunotherapy) administered before, during, or after SRS. Patients with prior brain surgery were excluded. We captured adverse events following SRS, including intralesional hemorrhage (IH), radiation necrosis (RN) and local failure (LF), as well as extracranial disease status. Distant brain failure (DBF), extracranial progression-free survival (PFS) and overall survival (OS) were determined using a cumulative Incidence function and the Kaplan-Meier method. RESULTS Our analysis included 165 patients with 570 SRS-treated MBM. Median OS for patients who received IO was 1.41 years versus 0.79 years in patients who did not (p = 0.04). Ipilimumab monotherapy was the most frequent IO regimen (30%). In the absence of IO, the cumulative incidence of symptomatic (grade 2 +) RN was 3% at 24 months and remained unchanged with respect to the type or timing of IO. The incidence of post-SRS g2 + IH in patients who did not receive systemic therapy was 19% at 1- and 2 years compared to 7% at 1- and 2 years among patients who did (HR: 0.33, 95% CI 0.11-0.98; p = 0.046). Overall, neither timing nor type of IO correlated to rates of DBF, OS, or LF. Among patients treated with IO, the median time to extracranial PFS was 5.4 months (95% IC 3.2 - 9.1). CONCLUSION The risk of g2 + IH exceeds that of g2 + RN in MBM patients undergoing SRS, with or without IO. IH should be considered a critical adverse event following MBM treatments.
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Affiliation(s)
- Paola A Jablonska
- Princess Margaret Cancer Centre, University Health Network, Toronto, Canada
| | - Thiago Muniz
- Department of Medical Oncology and Hematology, Princess Margaret Cancer Centre, University of Toronto, Toronto, Canada
| | - Mauricio Ribeiro
- Department of Medical Oncology and Hematology, Princess Margaret Cancer Centre, University of Toronto, Toronto, Canada
| | - Zhihui Amy Liu
- Department of Biostatistics, Princess Margaret Cancer Centre, University Health Network, 610 University Avenue, Toronto, ON, M5G 2M9, Canada
| | - Xiang Y Ye
- Department of Biostatistics, Princess Margaret Cancer Centre, University Health Network, 610 University Avenue, Toronto, ON, M5G 2M9, Canada
| | - Kaviya Devaraja
- Department of Medical Science, University of Toronto Institute and Princess Margaret Cancer Research Tower, Toronto, Canada
| | - Normand Laperriere
- Princess Margaret Cancer Centre, University Health Network, Toronto, Canada
| | - Barbara-Ann Millar
- Princess Margaret Cancer Centre, University Health Network, Toronto, Canada
| | - Tatiana Conrad
- Princess Margaret Cancer Centre, University Health Network, Toronto, Canada
| | - Paul Kongkham
- Department of Neurosurgery, Toronto Western Hospital, Toronto, Canada
| | - Marcus Butler
- Department of Medical Oncology and Hematology, Princess Margaret Cancer Centre, University of Toronto, Toronto, Canada
| | - David B Shultz
- Princess Margaret Cancer Centre, University Health Network, Toronto, Canada.
- , 700 University Avenue, 7Th Floor (Room 7-401), Toronto, ON, M5G 1Z5, Canada.
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Rose A, Kelly D, Hogg D, Butler M, Saibil S, Krema H, King I, Kamil ZS, Ghazarian D, Ceballos DA, Araujo D, Muniz T, Waldron J, Laperriere N, Spreafico A. 1144P Clinical predictors of therapeutic benefit from anti-PD1 immune checkpoint inhibitors (ICI) in patients (pts) with metastatic uveal melanoma. Ann Oncol 2020. [DOI: 10.1016/j.annonc.2020.08.1267] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
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de Lima S, Mietto BS, Paula C, Muniz T, Martinez AMB, Gardino PF. Rescuing axons from degeneration does not affect retinal ganglion cell death. Braz J Med Biol Res 2016; 49:e5106. [PMID: 27007653 PMCID: PMC4819409 DOI: 10.1590/1414-431x20155106] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2015] [Accepted: 10/28/2015] [Indexed: 11/22/2022] Open
Abstract
After a traumatic injury to the central nervous system, the distal stumps of axons undergo Wallerian degeneration (WD), an event that comprises cytoskeleton and myelin breakdown, astrocytic gliosis, and overexpression of proteins that inhibit axonal regrowth. By contrast, injured neuronal cell bodies show features characteristic of attempts to initiate the regenerative process of elongating their axons. The main molecular event that leads to WD is an increase in the intracellular calcium concentration, which activates calpains, calcium-dependent proteases that degrade cytoskeleton proteins. The aim of our study was to investigate whether preventing axonal degeneration would impact the survival of retinal ganglion cells (RGCs) after crushing the optic nerve. We observed that male Wistar rats (weighing 200-400 g; n=18) treated with an exogenous calpain inhibitor (20 mM) administered via direct application of the inhibitor embedded within the copolymer resin Evlax immediately following optic nerve crush showed a delay in the onset of WD. This delayed onset was characterized by a decrease in the number of degenerated fibers (P<0.05) and an increase in the number of preserved fibers (P<0.05) 4 days after injury. Additionally, most preserved fibers showed a normal G-ratio. These results indicated that calpain inhibition prevented the degeneration of optic nerve fibers, rescuing axons from the process of axonal degeneration. However, analysis of retinal ganglion cell survival demonstrated no difference between the calpain inhibitor- and vehicle-treated groups, suggesting that although the calpain inhibitor prevented axonal degeneration, it had no effect on RGC survival after optic nerve damage.
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Affiliation(s)
- S de Lima
- Laboratório de Neurobiologia da Retina, Centro de Ciências da Saúde, Instituto de Biofísica Carlos Chagas Filho, Rio de Janeiro, RJ, Brasil
| | - B S Mietto
- Laboratório de Neurodegeneração e Reparo, Departamento de Patologia, Faculdade de Medicina, Centro de Ciências da Saúde, Universidade Federal do Rio de Janeiro, Rio de Janeiro, RJ, Brasil
| | - C Paula
- Laboratório de Neurobiologia da Retina, Centro de Ciências da Saúde, Instituto de Biofísica Carlos Chagas Filho, Rio de Janeiro, RJ, Brasil
| | - T Muniz
- Laboratório de Neurobiologia da Retina, Centro de Ciências da Saúde, Instituto de Biofísica Carlos Chagas Filho, Rio de Janeiro, RJ, Brasil
| | - A M B Martinez
- Laboratório de Neurodegeneração e Reparo, Departamento de Patologia, Faculdade de Medicina, Centro de Ciências da Saúde, Universidade Federal do Rio de Janeiro, Rio de Janeiro, RJ, Brasil
| | - P F Gardino
- Laboratório de Neurobiologia da Retina, Centro de Ciências da Saúde, Instituto de Biofísica Carlos Chagas Filho, Rio de Janeiro, RJ, Brasil
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