Surgical management of cerebral metastases from melanoma: outcome in 147 patients treated at a single institution over two decades

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Object. The aim of this study was to review the outcome of patients who underwent surgery for treatment of cerebral metastatic melanoma.

Methods. A retrospective analysis was performed in 147 patients with cerebral metastases from melanoma who were treated surgically at a single institution between 1979 and 1999. Almost all patients underwent postoperative whole-brain radiation therapy. The mean patient age was 53 years (range 17–76 years); 69% of patients were male. A single cerebral metastasis was identified in 84% of patients, although 56% had synchronous extracranial metastases. The 30-day postoperative mortality rate was 2% and neurological symptoms resolved or improved in 78% of patients. Recurrence of intracerebral disease was seen in 55% of patients and 26% died of intracerebral metastases. Twenty-four patients underwent reoperation for recurrent cerebral disease. The median survival duration from the time of surgery for all patients was 8.5 months; the 3- and 5-year survival rates were 9% and 5%, respectively. Factors that significantly influenced survival on univariate analysis were the number of cerebral metastases (p = 0.015), a macroscopically complete excision (p < 0.05), and reoperation for recurrence (p = 0.02). The presence of extracranial metastases did not significantly influence survival. On multivariate analysis only the number of cerebral metastases significantly affected survival (p = 0.04).

Conclusions. For the majority of patients with cerebral metastases from melanoma, surgery with adjuvant radiation therapy is a treatment option that improves neurological symptoms and produces minimal morbidity. Long-term survival (> 3 years) most likely occurs in patients with a single cerebral metastasis and no demonstrable extracranial disease. Reoperation for recurrent cerebral disease may be appropriate in selected cases.

Article Information

Address reprint requests to: Andrew C. Zacest, M.B.B.S., Neurosurgery Department, Royal Adelaide Hospital, North Terrace, Adelaide, South Australia, 5000. email: azacest@mail.eisa.net.au.Address for Dr. Stevens: Oncology Unit, Dunedin Hospital, Dunedin, New Zealand.

© AANS, except where prohibited by US copyright law.

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Figures

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    Graph showing actuarial survival times in 147 patients in whom cerebral metastases from melanoma were diagnosed and who underwent surgery.

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    Graph showing actuarial survival times in patients in whom one or more cerebral melanoma metastasis (met) was found. The difference in median survival times is significant.

References

  • 1.

    Amer MAl-Sarraf MBaker LHet al: Malignant melanoma and central nervous system metastases: incidence, diagnosis, treatment and survival. Cancer 42:6606681978Amer M Al-Sarraf M Baker LH et al: Malignant melanoma and central nervous system metastases: incidence diagnosis treatment and survival. Cancer 42:660–668 1978

    • Search Google Scholar
    • Export Citation
  • 2.

    Amer MHAl-Sarraf MVaitkevicius VK: Clinical presentation, natural history and prognostic factors in advanced malignant melanoma. Surg Gynecol Obstet 149:6876921979Amer MH Al-Sarraf M Vaitkevicius VK: Clinical presentation natural history and prognostic factors in advanced malignant melanoma. Surg Gynecol Obstet 149:687–692 1979

    • Search Google Scholar
    • Export Citation
  • 3.

    Arbit EWronski MBurt Met al: The treatment of patients with recurrent brain metastases. A retrospective analysis of 109 patients with nonsmall cell lung cancer. Cancer 76:7657731995Arbit E Wronski M Burt M et al: The treatment of patients with recurrent brain metastases. A retrospective analysis of 109 patients with nonsmall cell lung cancer. Cancer 76:765–773 1995

    • Search Google Scholar
    • Export Citation
  • 4.

    Auchter RMLamond JPAlexander Eet al: A multiinstitutional outcome and prognostic factor analysis of radiosurgery for resectable single brain metastasis. Int J Radiat Oncol Biol Phys 35:27351996Auchter RM Lamond JP Alexander E et al: A multiinstitutional outcome and prognostic factor analysis of radiosurgery for resectable single brain metastasis. Int J Radiat Oncol Biol Phys 35:27–35 1996

    • Search Google Scholar
    • Export Citation
  • 5.

    Balch CMBuzaid ACSoong SJet al: Final version of the American Joint Committee on Cancer staging system for cutaneous melanoma. J Clin Oncol 19:363536482001Balch CM Buzaid AC Soong SJ et al: Final version of the American Joint Committee on Cancer staging system for cutaneous melanoma. J Clin Oncol 19:3635–3648 2001

    • Search Google Scholar
    • Export Citation
  • 6.

    Bindal AKBindal RKHess RKet al: Surgery versus radio-surgery in the treatment of brain metastases. J Neurosurg 84:7487541996Bindal AK Bindal RK Hess RK et al: Surgery versus radio-surgery in the treatment of brain metastases. J Neurosurg 84:748–754 1996

    • Search Google Scholar
    • Export Citation
  • 7.

    Bindal RJSawaya RLeavens MEet al: Reoperation for recurrent metastatic brain tumors. J Neurosurg 83:6006041995Bindal RJ Sawaya R Leavens ME et al: Reoperation for recurrent metastatic brain tumors. J Neurosurg 83:600–604 1995

    • Search Google Scholar
    • Export Citation
  • 8.

    Bindal RKSawaya RLeavens MEet al: Surgical treatment of multiple brain metastases. J Neurosurg 79:2102161993Bindal RK Sawaya R Leavens ME et al: Surgical treatment of multiple brain metastases. J Neurosurg 79:210–216 1993

    • Search Google Scholar
    • Export Citation
  • 9.

    Brega KRobinson WAWinston K: Surgical treatment of brain metastases in malignant melanoma. Cancer 66:210521101990Brega K Robinson WA Winston K: Surgical treatment of brain metastases in malignant melanoma. Cancer 66:2105–2110 1990

    • Search Google Scholar
    • Export Citation
  • 10.

    Byrne TNCascino TLPosner JB: Brain metastasis from melanoma. J Neurooncol 1:3133171983Byrne TN Cascino TL Posner JB: Brain metastasis from melanoma. J Neurooncol 1:313–317 1983

    • Search Google Scholar
    • Export Citation
  • 11.

    Coates MSTracey EA: Cancer in New South Wales: Incidence and Mortality 1999: Featuring 30 Years of Cancer Registration. Sydney: NSW Cancer Council2001Coates MS Tracey EA: Cancer in New South Wales: Incidence and Mortality 1999: Featuring 30 Years of Cancer Registration. Sydney: NSW Cancer Council 2001

    • Search Google Scholar
    • Export Citation
  • 12.

    Coory MArmstrong B: Cancer Incidence Projections for Area and Rural Health Services in New South Wales. Sydney: NSW Cancer Council1998Coory M Armstrong B: Cancer Incidence Projections for Area and Rural Health Services in New South Wales. Sydney: NSW Cancer Council 1998

    • Search Google Scholar
    • Export Citation
  • 13.

    Cox DR: Regression models and life tables. J R Stat Soc B 34:1872201972Cox DR: Regression models and life tables. J R Stat Soc B 34:187–220 1972

    • Search Google Scholar
    • Export Citation
  • 14.

    Damian DLFulham MJThompson Eet al: Positron emission tomography in the detection and management of metastatic melanoma. Melanoma Res 6:3253291996Damian DL Fulham MJ Thompson E et al: Positron emission tomography in the detection and management of metastatic melanoma. Melanoma Res 6:325–329 1996

    • Search Google Scholar
    • Export Citation
  • 15.

    Davey PO'Brien P: Disposition of cerebral metastases from malignant melanoma: implications for radiosurgery. Neurosurgery 28:8151991Davey P O'Brien P: Disposition of cerebral metastases from malignant melanoma: implications for radiosurgery. Neurosurgery 28:8–15 1991

    • Search Google Scholar
    • Export Citation
  • 16.

    Feun LGGutterman JBurgess MAet al: The natural history of resectable metastatic melanoma (Stage IVA melanoma). Cancer 50:165616631982Feun LG Gutterman J Burgess MA et al: The natural history of resectable metastatic melanoma (Stage IVA melanoma). Cancer 50:1656–1663 1982

    • Search Google Scholar
    • Export Citation
  • 17.

    Galicich JHSundaresan NArbit Eet al: Surgical treatment of single brain metastasis: factors associated with survival. Cancer 45:3813861980Galicich JH Sundaresan N Arbit E et al: Surgical treatment of single brain metastasis: factors associated with survival. Cancer 45:381–386 1980

    • Search Google Scholar
    • Export Citation
  • 18.

    Ginaldi SWallace SShalen Pet al: Cranial computed tomography of malignant melanoma. AJR 136:1451491981Ginaldi S Wallace S Shalen P et al: Cranial computed tomography of malignant melanoma. AJR 136:145–149 1981

    • Search Google Scholar
    • Export Citation
  • 19.

    Guazzo EPAtkinson RLWeidmann Met al: Management of solitary melanoma metastasis of the brain. Aust N Z J Surg 59:3213241989Guazzo EP Atkinson RL Weidmann M et al: Management of solitary melanoma metastasis of the brain. Aust N Z J Surg 59:321–324 1989

    • Search Google Scholar
    • Export Citation
  • 20.

    Hafstrom LJonsson PEStormblad LG: Intracranial metastases of malignant melanoma treated by surgery. Cancer 46:208820901980Hafstrom L Jonsson PE Stormblad LG: Intracranial metastases of malignant melanoma treated by surgery. Cancer 46:2088–2090 1980

    • Search Google Scholar
    • Export Citation
  • 21.

    Hagen NACirrincione CThaler HTet al: The role of radiation therapy following resection of single brain metastasis from melanoma. Neurology 40:1581601990Hagen NA Cirrincione C Thaler HT et al: The role of radiation therapy following resection of single brain metastasis from melanoma. Neurology 40:158–160 1990

    • Search Google Scholar
    • Export Citation
  • 22.

    Holder WD JrWhite RL JrZuger JHet al: Effectiveness of positron emission tomography for the detection of melanoma metastases. Ann Surg 227:7647711998Holder WD Jr White RL Jr Zuger JH et al: Effectiveness of positron emission tomography for the detection of melanoma metastases. Ann Surg 227:764–771 1998

    • Search Google Scholar
    • Export Citation
  • 23.

    Kaplan ELMeier P: Nonparametric estimation from incomplete observations. J Am Stat Assoc 53:4574811958Kaplan EL Meier P: Nonparametric estimation from incomplete observations. J Am Stat Assoc 53:457–481 1958

    • Search Google Scholar
    • Export Citation
  • 24.

    Karakousis CPVelez ADriscoll DLet al: Metastasectomy in malignant melanoma. Surgery 115:2953021994Karakousis CP Velez A Driscoll DL et al: Metastasectomy in malignant melanoma. Surgery 115:295–302 1994

    • Search Google Scholar
    • Export Citation
  • 25.

    Katz HR: The relative effectiveness of radiation therapy, corticosteroids, and surgery in the management of melanoma metastatic to the central nervous system. Int J Radiat Oncol Biol Phys 7:8979061981Katz HR: The relative effectiveness of radiation therapy corticosteroids and surgery in the management of melanoma metastatic to the central nervous system. Int J Radiat Oncol Biol Phys 7:897–906 1981

    • Search Google Scholar
    • Export Citation
  • 26.

    Kondziolka DBernstein MResch Let al: Significance of hemorrhage into brain tumors: clinicopathological study. J Neurosurg 67:8528571987Kondziolka D Bernstein M Resch L et al: Significance of hemorrhage into brain tumors: clinicopathological study. J Neurosurg 67:852–857 1987

    • Search Google Scholar
    • Export Citation
  • 27.

    Lavine SDPetrovich ZCohen-Gadol AAet al: Gamma knife radiosurgery for metastatic melanoma: an analysis of survival, outcome, and complications. Neurosurgery 44:59661999Lavine SD Petrovich Z Cohen-Gadol AA et al: Gamma knife radiosurgery for metastatic melanoma: an analysis of survival outcome and complications. Neurosurgery 44:59–66 1999

    • Search Google Scholar
    • Export Citation
  • 28.

    Madajewicz SKarakousis CWest CRet al: Malignant melanoma brain metastases. Review of Roswell Park Memorial Institute experience. Cancer 53:255025521984Madajewicz S Karakousis C West CR et al: Malignant melanoma brain metastases. Review of Roswell Park Memorial Institute experience. Cancer 53:2550–2552 1984

    • Search Google Scholar
    • Export Citation
  • 29.

    Marks RMcCarthy WH: Skin cancer: increasing incidence and public awareness. Med J Aust 153:5055061990Marks R McCarthy WH: Skin cancer: increasing incidence and public awareness. Med J Aust 153:505–506 1990

    • Search Google Scholar
    • Export Citation
  • 30.

    McCarthy WHMartyn ALRoberts Get al: Melanoma in New South Wales 1970–1976. Confirmation of increased incidence. Med J Aust 2:1371401980McCarthy WH Martyn AL Roberts G et al: Melanoma in New South Wales 1970–1976. Confirmation of increased incidence. Med J Aust 2:137–140 1980

    • Search Google Scholar
    • Export Citation
  • 31.

    Muacevic AKreth FWHorstmann GAet al: Surgery and radiotherapy compared with gamma knife radiosurgery in the treatment of solitary cerebral metastases of small diameter. J Neurosurg 91:35431999Muacevic A Kreth FW Horstmann GA et al: Surgery and radiotherapy compared with gamma knife radiosurgery in the treatment of solitary cerebral metastases of small diameter. J Neurosurg 91:35–43 1999

    • Search Google Scholar
    • Export Citation
  • 32.

    Noordijk EMVecht CJHaaxma-Reiche Het al: The choice of treatment of single brain metastasis should be based on extracranial tumor activity and age. Int J Radiat Oncol Biol Phys 29:7117171994Noordijk EM Vecht CJ Haaxma-Reiche H et al: The choice of treatment of single brain metastasis should be based on extracranial tumor activity and age. Int J Radiat Oncol Biol Phys 29:711–717 1994

    • Search Google Scholar
    • Export Citation
  • 33.

    Ott K: Surgery or radiosurgery? J Neurosurg 86:1651661997 (Letter)Ott K: Surgery or radiosurgery? J Neurosurg 86:165–166 1997 (Letter)

    • Search Google Scholar
    • Export Citation
  • 34.

    Overett TKShiu MH: Surgical treatment of distant metastatic melanoma. Indications and results. Cancer 56:122212301985Overett TK Shiu MH: Surgical treatment of distant metastatic melanoma. Indications and results. Cancer 56:1222–1230 1985

    • Search Google Scholar
    • Export Citation
  • 35.

    Patchell RATibbs PARegine WFet al: Postoperative radiotherapy in the treatment of single metastases to the brain: a randomized trial. JAMA 280:148514891998Patchell RA Tibbs PA Regine WF et al: Postoperative radiotherapy in the treatment of single metastases to the brain: a randomized trial. JAMA 280:1485–1489 1998

    • Search Google Scholar
    • Export Citation
  • 36.

    Patchell RATibbs PAWalsh JWet al: A randomized trial of surgery in the treatment of single metastases to the brain. N Engl J Med 322:4945001990Patchell RA Tibbs PA Walsh JW et al: A randomized trial of surgery in the treatment of single metastases to the brain. N Engl J Med 322:494–500 1990

    • Search Google Scholar
    • Export Citation
  • 37.

    Patel JKDidolkar MSPickren JWet al: Metastatic pattern of malignant melanoma. A study of 216 autopsy cases. Am J Surg 135:8078101978Patel JK Didolkar MS Pickren JW et al: Metastatic pattern of malignant melanoma. A study of 216 autopsy cases. Am J Surg 135:807–810 1978

    • Search Google Scholar
    • Export Citation
  • 38.

    Pennington DGMilton GW: Cerebral metastasis from melanoma. Aust N Z J Surg 45:4054091975Pennington DG Milton GW: Cerebral metastasis from melanoma. Aust N Z J Surg 45:405–409 1975

    • Search Google Scholar
    • Export Citation
  • 39.

    Rate WRSolin LJTurrisi AT: Palliative radiotherapy for metastatic malignant melanoma: brain metastases, bone metastases, and spinal cord compression. Int J Radiat Oncol Biol Phys 15:8598641988Rate WR Solin LJ Turrisi AT: Palliative radiotherapy for metastatic malignant melanoma: brain metastases bone metastases and spinal cord compression. Int J Radiat Oncol Biol Phys 15:859–864 1988

    • Search Google Scholar
    • Export Citation
  • 40.

    Rigel DSFriedman RJKopf AW: The incidence of malignant melanoma in the United States: issues as we approach the 21st century. J Am Acad Dermatol 34:8398471996Rigel DS Friedman RJ Kopf AW: The incidence of malignant melanoma in the United States: issues as we approach the 21st century. J Am Acad Dermatol 34:839–847 1996

    • Search Google Scholar
    • Export Citation
  • 41.

    Rinne DBaum RPHor Get al: Primary staging and follow-up of high risk melanoma patients with whole-body 18F fluorodeoxyglucose positron emission tomography: results of a prospective study of 100 patients. Cancer 82:166416711998Rinne D Baum RP Hor G et al: Primary staging and follow-up of high risk melanoma patients with whole-body 18F fluorodeoxyglucose positron emission tomography: results of a prospective study of 100 patients. Cancer 82:1664–1671 1998

    • Search Google Scholar
    • Export Citation
  • 42.

    Saha SMeyer MKrementz ETet al: Prognostic evaluation of intracranial metastasis in malignant melanoma. Ann Surg Oncol 1:38441994Saha S Meyer M Krementz ET et al: Prognostic evaluation of intracranial metastasis in malignant melanoma. Ann Surg Oncol 1:38–44 1994

    • Search Google Scholar
    • Export Citation
  • 43.

    Sampson JHCarter JH JrFriedman AHet al: Demographics, prognosis, and therapy in 702 patients with brain metastases from malignant melanoma. J Neurosurg 88:11201998Sampson JH Carter JH Jr Friedman AH et al: Demographics prognosis and therapy in 702 patients with brain metastases from malignant melanoma. J Neurosurg 88:11–20 1998

    • Search Google Scholar
    • Export Citation
  • 44.

    Seung SKSneed PKMcDermott MWet al: Gamma knife radiosurgery for malignant melanoma brain metastases. Cancer J Sci Am 4:1031091998Seung SK Sneed PK McDermott MW et al: Gamma knife radiosurgery for malignant melanoma brain metastases. Cancer J Sci Am 4:103–109 1998

    • Search Google Scholar
    • Export Citation
  • 45.

    Smalley SRLaws ER JrO'Fallon JRet al: Resection for solitary brain metastasis. Role of adjuvant radiation and prognostic variables in 229 patients. J Neurosurg 77:5315401992Smalley SR Laws ER Jr O'Fallon JR et al: Resection for solitary brain metastasis. Role of adjuvant radiation and prognostic variables in 229 patients. J Neurosurg 77:531–540 1992

    • Search Google Scholar
    • Export Citation
  • 46.

    Smalley SRSchray MFLaws ER Jret al: Adjuvant radiation therapy after surgical resection of solitary brain metastasis: association with pattern of failure and survival. Int J Rad Oncol Biol Phys 13:161116161987Smalley SR Schray MF Laws ER Jr et al: Adjuvant radiation therapy after surgical resection of solitary brain metastasis: association with pattern of failure and survival. Int J Rad Oncol Biol Phys 13:1611–1616 1987

    • Search Google Scholar
    • Export Citation
  • 47.

    Somaza SKondziolka DLunsford LDet al: Stereotactic radiosurgery for cerebral metastatic melanoma. J Neurosurg 79:6616661993Somaza S Kondziolka D Lunsford LD et al: Stereotactic radiosurgery for cerebral metastatic melanoma. J Neurosurg 79:661–666 1993

    • Search Google Scholar
    • Export Citation
  • 48.

    Stevens GFirth ICoates A: Cerebral metastases from malignant melanoma. Radiother Oncol 23:1851911992Stevens G Firth I Coates A: Cerebral metastases from malignant melanoma. Radiother Oncol 23:185–191 1992

    • Search Google Scholar
    • Export Citation
  • 49.

    Wronski MArbit E: Surgical treatment of brain metastases from melanoma: a retrospective study of 91 patients. J Neurosurg 93:9182000Wronski M Arbit E: Surgical treatment of brain metastases from melanoma: a retrospective study of 91 patients. J Neurosurg 93:9–18 2000

    • Search Google Scholar
    • Export Citation
  • 50.

    Wronski MArbit EBurt Met al: Survival after surgical treatment of brain metastases from lung cancer: a follow up study of 231 patients treated between 1976 and 1991. J Neurosurg 83:6056161995Wronski M Arbit E Burt M et al: Survival after surgical treatment of brain metastases from lung cancer: a follow up study of 231 patients treated between 1976 and 1991. J Neurosurg 83:605–616 1995

    • Search Google Scholar
    • Export Citation

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