Stereotactic Body Radiotherapy for Oligometastatic Disease in Melanoma Patients Receiving Immunotherapy: A Single-Center Retrospective Analysis

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Abstract
Background/Objectives: Metastatic melanoma increasingly includes clinical scenarios in which metastasis-directed treatment may complement systemic immunotherapy, particularly in oligometastatic disease. We evaluated outcomes of stereotactic body radiotherapy (SBRT) combined with immunotherapy in patients with metastatic melanoma, focusing on local control, survival, treatment sequencing, and safety. Methods: In this retrospective single-center study, 63 patients underwent SBRT for 97 extracranial metastatic lesions while receiving immune checkpoint inhibitors. The primary endpoint was local control (LC), while secondary endpoints included progression-free survival (PFS), overall survival (OS), and treatment-related toxicity. Results: LC rates at 12, 24, and 36 months were 95.9%, 89.7%, and 89.7%, respectively, demonstrating durable long-term control of treated lesions. Median OS was 47 months, while median PFS was not reached. A numerical trend toward longer PFS was observed among patients receiving SBRT during immunotherapy, although the differences were not statistically significant. No significant differences in LC were identified across oligometastatic disease subcategories. Combined treatment was well tolerated, with predominantly low-grade toxicity and no signal of increased immune-related adverse events. Conclusions: SBRT combined with immunotherapy appears to be a feasible and effective metastasis-directed treatment strategy in selected patients with metastatic melanoma. Durable local control, encouraging survival outcomes, and favorable tolerability support further prospective studies to optimize treatment sequencing and the integration of local and systemic therapies.

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