Immune checkpoint inhibitor therapy may increase the incidence of treatment-related necrosis after stereotactic radiosur
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Immune checkpoint inhibitor therapy may increase the incidence of treatment-related necrosis after stereotactic radiosurgery for brain metastases: a systematic review and meta-analysis Pyeong Hwa Kim 1 & Chong Hyun Suh 1 & Ho Sung Kim 1 & Kyung Won Kim 1 & Dong Yeong Kim 2 & Ayal A. Aizer 3 & Rifaquat Rahman 3 & Jeffrey P. Guenette 4 & Raymond Y. Huang 4 Received: 3 July 2020 / Revised: 28 September 2020 / Accepted: 12 November 2020 # European Society of Radiology 2020
Abstract Objectives To compare the incidence of treatment-related necrosis between combination SRS+ICI therapy and SRS therapy alone in patients with brain metastases from melanoma and non-small cell lung cancer (NSCLC). Methods A systematic literature search of Ovid-MEDLINE and EMBASE was performed up to August 10, 2020. The difference in the pooled incidence of treatment-related necrosis after SRS+ICI or SRS alone was evaluated. The cumulative incidence of treatment-related necrosis at the specific time point after the treatment was calculated and plotted. Subgroup and meta-regression analyses were additionally performed. Results Sixteen studies (14 on melanoma, 2 on NSCLC) were included. In NSCLC brain metastasis, the reported incidences of treatment-related necrosis in SRS+ICI and SRS alone ranged 2.9–3.4% and 0–2.9%, respectively. Meta-analysis was conducted including 14 studies on melanoma brain metastasis. The incidence of treatment-related necrosis was higher in SRS+ICI than SRS alone (16.0% vs. 6.5%; p = 0.065; OR, 2.35). The incidence showed rapid increase until 12 months after the SRS when combined with ICI therapy (14%; 95% CI, 8–22%) and its pace of increase slowed thereafter. Histopathologic diagnosis as the reference standard for treatment-related necrosis and inclusion of only symptomatic cases were the source of heterogeneity in SRS+ICI. Conclusions Treatment-related necrosis tended to occur 2.4 times more frequently in the setting of combination SRS+ICI therapy compared with SRS alone in melanoma brain metastasis showing high cumulative incidence within the first year. Treatmentrelated necrosis should be considered when SRS+ICI combination therapy is used for melanoma brain metastasis, especially in the first year. Key Points • Treatment-related necrosis occurred 2.4 times more frequently in the setting of combination SRS+ICI therapy compared with SRS alone in melanoma brain metastasis. • Treatment-related necrosis more frequently occurred in brain metastases from melanoma than NSCLC. • Reference standard for treatment-related necrosis and inclusion of only symptomatic treatment-related necrosis were a significant source of heterogeneity, indicating varying definitions of treatment-related necrosis in the literature need to be unified. Keywords Immunotherapy . Radiation . Radiosurgery . Neoplasm metastasis . Necrosis Jeffrey P. Guenette and Raymond Y. Huang contributed equally to this work. * Chong Hyun Suh [email protected] 1
Department of Radiology and Research Institute of Radiology, University of Ulsan College o
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