Efficacy and safety of hypofractionated radiotherapy for melanoma brain metastases: a retrospective study

Background and purpose Melanoma brain metastasis (MBM) is associated with a poor prognosis and a high risk of intracranial hemorrhage (ICH), which may complicate the use of stereotactic radiosurgery (SRS). This study evaluated the efficacy and safety of hypofractionated radiotherapy (HFRT) for MBM, with a specific focus on metastases with hemorrhagic components. Patients and methods In this single-center retrospective study, 26 patients with MBMs received HRT regimens of 30 Gy/5 fractions, 36 Gy/6 fractions, or 42 Gy/7 fractions. The primary endpoint was the local control (LC) rate assessed on the first MRI evaluation after radiotherapy completion (1–3 months after radiotherapy completion). Secondary endpoints included intracranial progression-free survival (IPFS), overall survival (OS), and treatment-related adverse events (AEs). Results The disease control rate was 96% at the 3-month assessment (2 complete responses, 16 partial responses, 7 stable disease). The median OS was 10.5 months and the median IPFS was 4.5 months. No grade ≥3 AEs or symptomatic radiation necrosis occurred during the follow-up period (median 7.5 months). Notably, no radiotherapy-related ICH or exacerbation of pre-existing hemorrhage was observed, and hemorrhage reduction was achieved in all 11 patients with baseline ICH (100%). Conclusion HFRT demonstrated promising local control and a favorable safety profile in this cohort of MBM patients, It shows particular potential for treating hemorrhagic metastases and may offer a valuable alternative to SRS in selected high-risk scenarios, meriting further investigation in larger studies.