Critical appraisal:Bates JE, Youn P, Usuki KY, Walter KA, Huggins CF, Okunieff P, et al 2015

Critical Appraisal

Article being appraised

Bates JE, Youn P, Usuki KY, Walter KA, Huggins CF, Okunieff P, et al. Brain metastasis from melanoma: the prognostic value of varying sites of extracranial disease. J Neurooncol 2015 Nov;125(2):411-8 Available from: http://www.ncbi.nlm.nih.gov/pubmed/26354772.

Applicable clinical question

When is radiotherapy indicated for patients with distant metastasis?

Key Facts

Study Design

cohort study

Study aims:

To further characterise the role of SRS and/or WBRT in patients with brain-metastatic melanoma in a retrospective manner based on the experience of a single major academic medical institution.

Number of Patients:

73

Fourteen (19.2%) patients receieved SRS alone, 39 (53.4%) received WBRT alone, and 20 (27.4%) received both SRS and WBRT.

Reported outcome(s):

Overall survival (OS), progression free survival (PFS), brain progression free survival (BPFS)

Results of outcome(s):

The median overall survival (OS) for this cohort was 3 months.
Patients with three or more distinct sites of intracranial disease (n=39, OS= 1.8 months, HR= 1.98, p= 0.005) did significantly worse than those with one or two sites of intracranial disease (n= 34, OS= 7 months).
Patients who received SRS alone (OS= 11.9 months, HR= 0.38, 95% CI 0.21-0.68, p= 0.001) or SRS and WBRT (OS= 3.8 months, HR= 0.51, 95%CI 0.27-0.97, p= 0.04) had improved OS compared to those who received WBRT alone (OS= 1.9 months).

Those patients who received SRS alone (BPFS= 4.0 months, HR= 0.53, 95%CI 0.30-0.91, p= 0.02) had improved BPFS, compared to those who received WBRT alone (BPFS= 1.4 months), while those who received SRS + WBRT (BPFS= 3.2 months, HR= 0.61, 95%CI 0.32-1.16, p= 0.13) had no significant change in BPFS.

Includes an economic evaluation

no