Multimodality treatment of melanoma brain metastases incorporating stereotactic radiosurgery (SRS)

Authors

  • Wolfram E. Samlowski MD,

    Corresponding author
    1. Huntsman Cancer Institute, University of Utah, Salt Lake City, Utah
    2. Department of Internal Medicine (Division of Oncology), University of Utah, Salt Lake City, Utah
    • Huntsman Cancer Institute, Suite 2100, 2000 Circle of Hope Dr., Salt Lake City, UT 84112
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    • Fax: (801) 585-7477

  • Gordon A. Watson MD, PhD,

    1. Huntsman Cancer Institute, University of Utah, Salt Lake City, Utah
    2. Department of Radiation Therapy, University of Utah, Salt Lake City, Utah
    Current affiliation:
    1. Department of Radiation Therapy, LDS Hospital, Salt Lake City, UT
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  • Michael Wang MD,

    1. Huntsman Cancer Institute, University of Utah, Salt Lake City, Utah
    2. Department of Internal Medicine (Division of Oncology), University of Utah, Salt Lake City, Utah
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  • Ganesh Rao MD,

    1. Huntsman Cancer Institute, University of Utah, Salt Lake City, Utah
    2. Department of Internal Medicine (Division of Oncology), University of Utah, Salt Lake City, Utah
    3. Department of Neurosurgery, University of Utah, Salt Lake City, Utah
    Current affiliation:
    1. Department of Neurosurgery, University of Texas M. D. Anderson Cancer Center, Houston, TX
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  • Paul Klimo Jr MD, MPH,

    1. Huntsman Cancer Institute, University of Utah, Salt Lake City, Utah
    2. Department of Internal Medicine (Division of Oncology), University of Utah, Salt Lake City, Utah
    3. Department of Neurosurgery, University of Utah, Salt Lake City, Utah
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  • Kenneth Boucher PhD,

    1. Huntsman Cancer Institute, University of Utah, Salt Lake City, Utah
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  • Dennis C. Shrieve MD, PhD,

    1. Huntsman Cancer Institute, University of Utah, Salt Lake City, Utah
    2. Department of Internal Medicine (Division of Oncology), University of Utah, Salt Lake City, Utah
    3. Department of Radiation Therapy, University of Utah, Salt Lake City, Utah
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  • Randy L. Jensen MD, PhD

    1. Huntsman Cancer Institute, University of Utah, Salt Lake City, Utah
    2. Department of Internal Medicine (Division of Oncology), University of Utah, Salt Lake City, Utah
    3. Department of Neurosurgery, University of Utah, Salt Lake City, Utah
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Abstract

BACKGROUND.

Brain metastases are a frequent complication in advanced melanoma. A 3.6 to 4.1-month 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)-based stereotactic radiosurgery (SRS).

METHODS.

Forty-four melanoma patients with brain metastases underwent 66 SRS treatments for 156 metastatic foci between 1999 and 2004. Patients were treated with initial SRS if ≤5 brain metastases were present. All patients had Karnofsky Performance Status (KPS) ≥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 follow-up 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]: 8.2–14.9 months) from diagnosis. One-year and 2-year 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. © 2007 American Cancer Society.

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