Abstract
BACKGROUND.
Brain metastases are a frequent complication in advanced melanoma. A 3.6 to 4.1βmonth median survival has been reported after treatment with whole brain radiotherapy. We performed a retrospective analysis of our institutional experience of multimodality treatment utilizing linear accelerator (Linac)βbased stereotactic radiosurgery (SRS).
METHODS.
Fortyβfour melanoma patients with brain metastases underwent 66 SRS treatments for 156 metastatic foci between 1999 and 2004. Patients were treated with initial SRS if β€5 brain metastases were present. All patients had Karnofsky Performance Status (KPS) β₯70, but 37 patients had active systemic metastases (Recursive Partition Analysis Class 2). Survival was calculated from the time of diagnosis of brain metastases. Minimum followβup was 1 year after SRS. The potential role of prognostic factors on survival was evaluated including age, sex, interval from initial diagnosis to brain metastases, surgical resection, addition of whole brain radiotherapy (WBRT), number of initial metastases treated, and number of SRS treatments using Cox univariate analysis.
RESULTS.
The median survival of melanoma patients with brain metastases was 11.1 months (95% confidence interval [CI]: 8.2β14.9 months) from diagnosis. Oneβyear and 2βyear survivals were 47.7% and 17.7%, respectively. There was no apparent effect of age or sex. Surgery or multiple stereotactic radiotherapy treatments were associated with prolonged survival. Addition of WBRT to maintain control of brain metastases in a subset of patients did not improve survival.
CONCLUSIONS.
Our results suggest that aggressive treatment of patients with up to 5 melanoma brain metastases including SRS appears to prolong survival. Subsequent chemotherapy or immunotherapy after SRS may have contributed to the observed outcome. Cancer 2007. Β© 2007 American Cancer Society.