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Prognostic factors for survival in melanoma patients with brain metastases†
Article first published online: 19 OCT 2010
Copyright © 2010 American Cancer Society
Volume 117, Issue 8, pages 1687–1696, 15 April 2011
How to Cite
Davies, M. A., Liu, P., McIntyre, S., Kim, K. B., Papadopoulos, N., Hwu, W.-J., Hwu, P. and Bedikian, A. (2011), Prognostic factors for survival in melanoma patients with brain metastases. Cancer, 117: 1687–1696. doi: 10.1002/cncr.25634
See editorial and companion articles on pages 1560-3, 1697-703, and 1711-20, this issue.
- Issue published online: 6 APR 2011
- Article first published online: 19 OCT 2010
- Manuscript Accepted: 24 AUG 2010
- Manuscript Revised: 19 AUG 2010
- Manuscript Received: 7 MAY 2010
- brain metastases;
- leptomeningeal disease;
- prognostic factor
One of the most common and deadly complications of melanoma is brain metastases. The outcomes of advanced melanoma patients who developed brain metastases were reviewed to identify significant prognostic factors for overall survival (OS).
An institutional database of advanced melanoma patients enrolled on clinical trials in the Department of Melanoma Medical Oncology from 1986 to 2004 was reviewed and patients who developed brain metastases were identified. Date of diagnosis, patient age, pattern of brain involvement, timing relative to extracranial metastases, prior response to systemic therapy, and treatments given for brain metastases were assessed as potential prognostic factors for OS.
Among 743 melanoma patients enrolled in clinical trials for regional or systemic metastatic disease, 330 (44%) patients developed brain metastases. The median OS after the diagnosis of brain metastases was 4.7 months. Diagnosis before 1996, increased number of parenchymal brain metastases, leptomeningeal involvement, and development of brain metastases after receiving systemic therapy for extracranial metastases were found to be significant prognostic factors for OS. Among patients who received systemic therapy as the initial treatment of brain metastases, patients who previously responded to systemic therapies had longer survival than patients who had not responded.
The era, pattern, and timing of melanoma brain metastases were found to be strongly associated with survival. Previous responsiveness to systemic therapies did not predict better outcomes overall, but it did correlate with improved survival for patients with brain metastases who were treated with systemic therapies. These factors may be used in guiding patient management and for stratifying patients in clinical trials. Cancer 2011. © 2010 American Cancer Society.