Plenary Oral Presentations - Macquarie University Hospital

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16 th International Meeting of the Leksell Gamma Knife ® SocietyMarch 2012, Sydney, AustraliaMA-280Stereotactic radiosurgery of brain metastases in elderlypatients: the cleveland clinic experience1Manmeet Ahluwalia, 1 Neda Hashemi-Sadraei, 2 John Suh, 1 Sam Chao, 1 Lilyana Angelov,1Robert Weil, 1 Michael Vogelbaum, 3 Paul Elson, 1 Gene Barnett1Burkhardt Brain Tumor and Neuro-Oncology Center, Cleveland Clinic2Taussig Cancer Institute, Cleveland Clinic3Quantitative Health Sciences, Cleveland ClinicObjective: Elderly patients often suffer from cerebrovascular impairment. Whole brain radiotherapy(WBRT) can cause vascular damage and enhances the risk of dementia. For patients with a limitednumber of brain metastases (BM) stereotactic radiosurgery (SRS) is promising alternative. This studywas designed to evaluate the therapeutic effect of SRS in patients aged ≥70 years who presented withBM.Methods: The IRB-approved Cleveland Clinic Brain Tumor and Neuro-Oncology Center’s databasewas used to identify patients with BM who were ≥70 years at the time of diagnosis of BM and weretreated with SRS between 8/2000 and 12/2009. Multivariable analysis was conducted to identifyindependent predictors of survival using a Cox proportional hazards model and a stepwise selectionalgorithm with p=0.10 and p=0.05 as criteria for entry and retention.Results: 173 BM patients with a median age of 75 years (range 70-87, 64% male) were included.Most patients had either lung cancer (55%, 95/173) or kidney cancer (16%, 28/173) primaries.Median time between diagnosis of the primary cancer and BM was 10.3 months (0-309.6 months).Forty-six percent (79/173) of patients had multiple BM and 57% (99/173) had extra-cranial metastasesat the time BM was diagnosed. Median overall survival (OS) was 5.5 months from the time of SRS(95% CI, 4.4-7.2 months). Cause of death was extracranial tumor progression in 35% of the patients,cranial tumor progression in only 3%, both cranial and extracranial tumor progression in 9%, andthe cause of death was unknown in 53%.Conclusions: In multivariable analysis, performance status, the interval from diagnosis of the primarycancer to BM, WBRT prior to SRS and presence of extracranial metastasis were all identified asindependent predictors of OS. SRS is a well tolerated and effective treatment for elderly patients.50
16 th International Meeting of the Leksell Gamma Knife ® SocietyMarch 2012, Sydney, AustraliaMA-282Is Ipilimumab effective in melanoma with limited brainmetastasis treated with Gamma Knife procedure?Maya Mary MathewNew York <strong>University</strong> Langone Medical Center,NY, NY, USAObjective: Brain metastasis in melanoma carries a poor prognosis with an overall survival of 3-5months and minimal response to systemic therapy. Ipilimumab, a human IgG monoclonal antibodyagainst CTLA-4, has shown to improve the survival in patients with metastatic non-CNS melanoma.Its ability to cross the blood brain barrier or as a radiation sensitizer is not clear at this time. Thepurpose of this study was to investigate the efficacy of Ipilimumab in the treatment of metastaticmelanoma with limited brain metastases treated with Gamma Knife (GK).Methods: From 2008-2010, 55 patients with limited brain metastases from melanoma were treatedwith GK procedure. SRS was delivered to a median dose of 20 Gy delivered to 50% isodose line(Range15-20). The median number of lesions treated were 3 (Range 1-8). Ipilimumab was administeredintravenously at 3mg/kg over 90 minutes every 3 weeks for a median of 4 doses (Range1-8) in 23patients. Local control (LC), Progression free survival (PFS) and overall survival (OS) were assessedfrom the date of GK procedure.Results: The median LC, PFS and OS for the entire group were 8, 6 and 5 months respectively. Thecause of death was CNS progression in all but two patients. Salvage therapy was needed in 26(47.3%) patients that included repeat GK in 20 and Whole Brain Radiotherapy in 7 patients. The 6month LC, median PFS and median OS were 62.9%, 5 months and 6 months respectively in patientswho received Ipilimumab and 62.6%, 7 months and 5 months respectively in patients who didn’treceive Ipilimumab ( p=ns). Intracranial hemorrhage was noted in 7 patients who received Ipilimumabcompared to 9 in those who didn’t receive it (p=ns).Conclusions: Administration of Ipilimumab does not appear to affect outcomes in patients withlimited brain metastases who received GK procedure.51
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