Nuclear Medicine & Radiation Therapy

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

Abstract

Phillip A. Choi, Ajay Niranjan, Hideyuki Kano, L. Dade Lunsford and Edward A. Monaco III

Advances in the treatment of melanoma with novel systemic therapies have meaningfully increased survival of patients. The brain is a common early site for melanoma metastases. WBRT is of limited effectiveness for radioresistant histologies such as melanoma and has been associated with white matter change and cognitive dysfunction. Prior studies of leukoencephalopathy after treatment with whole-brain radiation therapy (WBRT) and/or stereotactic radiosurgery (SRS) have focused on pathologies where chemotherapy is reflexively used in the majority of patients. The study’s aim was to evaluate the risk of leukoencephalopathy in patients with melanoma brain metastases receiving stereotactic radiosurgery and whole-brain radiation therapy versus SRS alone. We retrospectively reviewed 63 patients who underwent SRS with or without WBT between April 1988 and December 2012. Degree of leukoencephalopathy was evaluated on T2 and FLAIR MRI sequences using a simple, previouslydescribed method. A significantly lower proportion of patients treated with SRS developed leukoencephalopathy in long-term follow up compared to patients treated with SRS and WBRT. This study demonstrates an increased risk of leukoencephalopathy following WBRT compared to SRS alone in a cohort of melanoma brain metastases patients with a low rate of treatment with alkylating chemotherapeutic agents.