To evaluate the role of stereotactic radiosurgery (SRS) in the management of brain metastases from melanoma, the authors assessed clinical outcomes and prognostic factors for survival and tumor control.
The authors reviewed 333 consecutive patients with melanoma who underwent SRS for 1570 brain metastases from cutaneous and mucosal/acral melanoma. The patient population consisted of 109 female and 224 male patients with a median age of 53 years. Two hundred eleven patients (63%) had multiple metastases. One hundred eighteen patients (35%) underwent whole-brain radiation therapy (WBRT). The target volume ranged from 0.1 cm3 to 37.2 cm3. The median marginal dose was 18 Gy.
Actuarial survival rates were 70% at 3 months, 47% at 6 months, 25% at 12 months, and 10% at 24 months after radiosurgery. Factors associated with longer survival included controlled extracranial disease, better Karnofsky Performance Scale score, fewer brain metastases, no prior WBRT, no prior chemotherapy, administration of immunotherapy, and no intratumoral hemorrhage before radiosurgery. The median survival for patients with a solitary brain metastasis, controlled extracranial disease, and administration of immunotherapy after radiosurgery was 22 months. Sustained local tumor control was achieved in 73% of the patients. Sixty-four (25%) of 259 patients who had follow-up imaging after SRS had evidence of delayed intratumoral hemorrhage. Sixteen patients underwent a craniotomy due to intratumoral hemorrhage. Seventeen patients (6%) had asymptomatic and 21 patients (7%) had symptomatic radiation effects. Patients with ≤ 8 brain metastases, no prior WBRT, and the recursive partitioning analysis Class I had extended survivals (median 54.3 months).
Stereotactic radiosurgery is an especially valuable option for patients with controlled systemic disease even if they have multiple metastatic brain tumors.
Abbreviations used in this paper: HFS = hemorrhage-free survival; HR = hazard ratio; KPS = Karnofsky Performance Scale; OS = overall survival; PFS = progression-free survival; RPA = recursive partitioning analysis; SIR = score index of radiosurgery; SRS = stereotactic radiosurgery; WBRT = whole-brain radiation therapy.
* Drs. Liew and Kano contributed equally to this work.
Address correspondence to: L. Dade Lunsford, M.D., Department of Neurological Surgery, University of Pittsburgh, Suite B-400, UPMC Presbyterian, 200 Lothrop Street, Pittsburgh, Pennsylvania 15213. email: firstname.lastname@example.org.
Please include this information when citing this paper: published online June 4, 2010; DOI: 10.3171/2010.5.JNS1014.
AtkinsMBSosmanJAAgarwalaSLoganTClarkJIErnstoffMS: Temozolomide, thalidomide, and whole brain radiation therapy for patients with brain metastasis from metastatic melanoma: a phase II Cytokine Working Group study. Cancer113:2139–21452008
BamiasAAravantinosGDeliveliotisCBafaloukosDKalofonosCXirosN: Docetaxel and cisplatin with granulocyte colony-stimulating factor (G-CSF) versus MVAC with G-CSF in advanced urothelial carcinoma: a multicenter, randomized, phase III study from the Hellenic Cooperative Oncology Group. J Clin Oncol22:220–2282004
BuchsbaumJCSuhJHLeeSYChidelMAGreskovichJFBarnettGH: Survival by radiation therapy oncology group recursive partitioning analysis class and treatment modality in patients with brain metastases from malignant melanoma: a retrospective study. Cancer94:2265–22722002
Gaudy-MarquesteCRegisJMMuraccioleXLauransRRichardMABonerandiJJ: Gamma-Knife radiosurgery in the management of melanoma patients with brain metastases: a series of 106 patients without whole-brain radiotherapy. Int J Radiat Oncol Biol Phys65:809–8162006
KornELLiuPYLeeSJChapmanJANiedzwieckiDSumanVJ: Meta-analysis of phase II cooperative group trials in metastatic stage IV melanoma to determine progression-free and overall survival benchmarks for future phase II trials. J Clin Oncol26:527–5342008
KouvarisJRMiliadouAKoulouliasVEKolokourisDBalafoutaMJPapacharalampousXN: Phase II study of temozolomide and concomitant whole-brain radiotherapy in patients with brain metastases from solid tumors. Onkologie30:361–3662007
LagerwaardFJLevendagPCNowakPJEijkenboomWMHanssensPESchmitzPI: Identification of prognostic factors in patients with brain metastases: a review of 1292 patients. Int J Radiat Oncol Biol Phys43:795–8031999
LorenzoniJDevriendtDMassagerNDavidPRuízSVanderlindenB: Radiosurgery for treatment of brain metastases: estimation of patient eligibility using three stratification systems. Int J Radiat Oncol Biol Phys60:218–2242004
ManonRO'NeillAKniselyJWerner-WasikMLazarusHMWagnerH: Phase II trial of radiosurgery for one to three newly diagnosed brain metastases from renal cell carcinoma, melanoma, and sarcoma: an Eastern Cooperative Oncology Group study (E 6397). J Clin Oncol23:8870–88762005
MoriYKondziolkaDFlickingerJCKirkwoodJMAgarwalaSLunsfordLD: Stereotactic radiosurgery for cerebral metastatic melanoma: factors affecting local disease control and survival. Int J Radiat Oncol Biol Phys42:581–5891998
PowellJWChungCTShahHRCanuteGWHodgeCJBassanoDA: Gamma Knife surgery in the management of radioresistant brain metastases in high-risk patients with melanoma, renal cell carcinoma, and sarcoma. J Neurosurg109:Suppl122–1282008
SinAHCardenasRJVannemreddyPNandaA: Gamma Knife stereotactic radiosurgery for intracranial metastases from conventionally radioresistant primary cancers: outcome analysis of survival and control of brain disease. South Med J102:42–442009
TarhiniAAKirkwoodJMGoodingWEMoschosSAgarwalaSS: A phase 2 trial of sequential temozolomide chemotherapy followed by high-dose interleukin 2 immunotherapy for metastatic melanoma. Cancer113:1632–16402008
ZacestACBesserMStevensGThompsonJFMcCarthyWHCuljakG: Surgical management of cerebral metastases from melanoma: outcome in 147 patients treated at a single institution over two decades. J Neurosurg96:552–5582002