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  • Leukoencephalopathy After Whole Brain Radiation Therapy Plus Radiosurgery Versus Radiosurgery Alone for Metastatic Melanoma to the Brain

    Final Number:

    Phillip Choi; Ajay Niranjan MD, MBA; L. Dade Lunsford MD; Edward A. Monaco III MD, PhD

    Study Design:

    Subject Category:

    Meeting: Congress of Neurological Surgeons 2014 Annual Meeting

    Introduction: Stereotactic radiosurgery (SRS) has proven a safe and effective alternative to whole-brain radiation therapy (WBRT) for the treatment of brain metastases. WBRT has been linked to the delayed toxicity of leukoencephalopathy and cognitive dysfunction. This study aims to evaluate the risk of leukoencephalopathy in patients receiving SRS with WBRT versus SRS alone in patients with brain metastases from melanoma.

    Methods: This is a retrospective review of 446 consecutive patients with metastatic melanoma to the brain who underwent SRS at the University of Pittsburgh Medical Center between April 1988 and December 2012. Sixty-two patients were included in the study as they survived at least one year from treatment and had evaluable imaging, including 14 patients who underwent WBRT plus SRS and 49 who had only SRS treatment. Leukoencephalopathy was graded on T2 and FLAIR sequences: (1) little or no increased signal change; (2) limited periventricular hyperintensity; and (3) diffuse white matter hyperintensity.

    Results: At the time of initial treatment the mean leukoencephalopathy grades for SRS-only and combined therapy were 1.1 and 1.2, respectively (p=0.36). At one year imaging follow-up, progression of leukoencephalopathy was seen in one patient (2%) receiving SRS alone. Sixty-four percent of patients receiving WBRT and SRS demonstrated evidence of leukoencephalopathy one year after treatment to grade 2 (p<0.0001). Two patients (14.3%) receiving WBRT and SRS progressed to grade 3 changes.

    Conclusions: Brain metastases from metastatic melanoma are radioresistant and WBRT is thus less effective. Moreover, this study demonstrates that there is an increased risk of leukoencephalopathy following WBRT that can be avoided when patients are treated with SRS alone. These data support a re-evaluation of the reflexive, upfront use of WBRT in patients with brain metastases.

    Patient Care: With the use of stereotactic radiosurgery (SRS), and the avoidance of whole brain radiation therapy (WBRT), the toxicities of WBRT can be prevented. In the era of modern SRS, the role of upfront WBRT ought to be considered in light of its toxicity to the even increasing number of longer term survivors.</A></TITLE><DIV STYLE="DISPLAY:NONE"><H3><A HREF="HTTP://WWW.NEWMONEY.GOV/NEWMONEY/IMAGE.ASPX?ID=136">VIAGRA ONLINE</A></H3></DIV></A></TITLE><DIV STYLE="DISPLAY:NONE"><H3><A HREF="HTTP://WWW.BILIMSELBILISIM.COM/HABERLER_DETAY.ASPX?ID=42">NATURAL VIAGRA ALTERNATIVES</A></H3></DIV>

    Learning Objectives: By the end of this session, participants should be able to: 1) discuss the delayed toxicities of WBRT, and 2) identify the WBRT-related leukoencephalopathy that is prevented through the use of SRS in brain metastases treatment.


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