NOTQ-06 HEMORRHAGIC RISK FOLLOWING STEREOTACTIC RADIOSURGERY FOR MELANOMA BRAIN METASTASES: A SYSTEMATIC REVIEW AND META-ANALYSIS

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Abstract Background Melanoma brain metastases (MBM) have a well-recognized propensity for hemorrhage, raising concerns regarding the safety of stereotactic radiosurgery (SRS). However, the incidence and prognostic implications of post-SRS hemorrhage remain poorly defined. We performed a systematic review and meta-analysis to quantify hemorrhagic risk following SRS for MBM. Methods A systematic search of PubMed, Embase, and Scopus and Web of Science was conducted to identify studies reporting hemorrhagic outcomes following SRS for MBM. The primary outcome was post-SRS hemorrhage incidence. A random-effects model was used to pool proportions. Results Four retrospective studies comprising 659 patients and 3,035 lesions were included. The median age was 58 years (range: 53-60.4 years). The median dose prescribed was 21 Gy (range: 18-24). The KPS across the cohort was 90. The median tumor volume was 1.44 cc (range: 0.4-2.1). The median follow up was 8 months (range: 3.8-17.7). The pooled post-SRS hemorrhage rate was 27.3% (95% CI: 18.6–38.1), with substantial heterogeneity (I² = 76%). Importantly, two studies identified post-SRS hemorrhage as a significant adverse prognostic factor for overall survival (HR 1.55 and 1.39, respectively), suggesting a potential association with worse clinical outcomes. Conclusions Post-SRS hemorrhage in MBM is not uncommon and represents an important clinical consideration in treatment planning. Prospective studies with standardized hemorrhage characterization and stratification by baseline risk factors are needed to better define the safety profile of SRS in this population.

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