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Melanoma Brain Metastases and Associated Intracerebral Bleeds: The Role of Whole-Brain Radiation Therapy and BRAF Mutation

Friday, May 3, 2024

Presenting Author(s)

Samantha Schimmel

Medical Student
University of South Florida Morsani College of Medicine
Tampa, FL, US

Co-Author(s)

Adam Alayli

Medical Student
University of South Florida Morsani College of Medicine
Tampa, FL, US
BE

Bassel El Sayed, n/a

Medical Student
University of South Florida Morsani College of Medicine
Tampa, Florida, United States
JG

Jonah Gordon, n/a

Medical Student
University of South Florida Morsani College of Medicine
Tampa, Florida, United States
VI

Vishnu V. Iyer, n/a

Medical Student
University of South Florida Morsani College of Medicine, United States
PJ

Peter Johnstone, MD

Radiation Oncologist
Department of Radiation Oncology, H. Lee Moffitt Cancer Center and Research Institute, United States
PK

Paul Kraftt, MD

Neurosurgeon
Lillian S. Wells Department of Neurosurgery at the University of Florida, United States
GL

Gavin Lockard, n/a

Medical Student
University of South Florida Morsani College of Medicine
Tampa, Florida, United States
DP

Dylan Parker, MS

Medical Student
University of South Florida Morsani College of Medicine
Wesley Chapel, Florida, United States
Ivo Peto, MD

Neurosurgery Resident
Department of Neurosurgery and Brain Repair, University of South Florida
Tampa, FL, US
Nam D. Tran, MD, PhD

Neurosurgeon
Department of Neuro-Oncology, H. Lee Moffitt Cancer Center and Research Institute
Tampa, Florida, United States

Introduction: It is well recognized that melanoma has a predilection for brain involvement; however, its propensity of causing an intracerebral hemorrhage (ICH) has yet to be determined. The purpose of this current study was to describe the natural history of metastatic melanoma-associated ICH, and to evaluate its occurrence in the setting of prior whole-brain radiation therapy (WBRT) and in patients with a BRAF mutation.

Methods: Following institutional review board approval, a retrospective chart review was performed on all patients with malignant brain metastasis who underwent WBRT at our institution. Data collected included demographic data, BRAF status, and radiographic characteristics.

Results: A total of 1,120 patients with melanoma brain metastases and WBRT were identified, with 182 (16.3 %) diagnosed with a tumor-associated brain hemorrhage following radiation. Only 45% (81/182) had testing for the presence of the BRAF v600e mutation. Amongst the brain hemorrhage group with known BRAF status (42/81), the preponderance harbored a BRAF v600e mutation (30/42, 71.4%), while 12 (28.6%) did not. BRAF status, mutant versus wild type, was significantly associated with the time between radiation therapy and hemorrhage (p < 0.001, 95% CI 95.61- 102.03), with BRAF mutant patients developing bleeds sooner after radiation therapy (80.57±1.64 days versus 121.08±3.18 days).

Conclusion : The time between tumor-associated ICH and radiation therapy is associated with BRAF mutation status. This warrants further investigations to see whether other mitigating factors, such as systemic or immunotherapy, may contribute to brain hemorrhage following radiation.