Brain and leptomeningeal metastases from cutaneous melanoma: Survival outcomes based on clinical features

Abstract

Brain metastases (BM) are among the most devastating and debilitating complications of melanoma. This retrospective study was conducted to gain a better understanding of patient and disease characteristics that have the greatest impact on overall survival in melanoma patients with BM; therapeutic interventions were also assessed. The records of all patients diagnosed with cutaneous melanoma and BM who were seen at Memorial Sloan-Kettering Cancer Center between 1991 and 2001 were retrospectively reviewed. A variety of factors, including age at diagnosis of stage IV disease, gender, race, disease stage at diagnosis, presence of BM at diagnosis of stage IV disease, neurologic symptoms, radiographic findings, number of BM, status and site(s) of extracranial metastasis, and treatment modalities, were analyzed for correlation with overall survival using univariate and multivariate Cox regression models. The records of 355 patients with BM were included in the analysis. On univariate analysis, seven patient and disease characteristics were significantly associated with poorer survival: age > 65 years, extracranial metastases, BM at stage IV diagnosis, neurologic symptoms, four or more BM, hydrocephalus, and leptomeningeal metastases. Of these, age, extracranial metastasis, neurologic symptoms, and number of BM were significantly associated with poorer survival in a multivariate analysis. Multivariate analysis of treatment modalities suggested that patients who had surgery, radiosurgery, or chemotherapy with temozolomide had improved survival outcomes, although this analysis has limitations. The prognostic factors identified in this retrospective study should be considered when making treatment decisions for patients with BM and used as stratification factors in future clinical trials.

Malignant Melanoma S3‐Guideline “Diagnosis, Therapy and Follow‐up of Melanoma”

“…There was no statistically significant benefit for whole-brain irradiation in these studies. Raizer et al were able to demonstrate a twofold rise in survival time from 2 to 4 months by whole-brain radiation therapy, without showing statistical significance [575].…”

“…In a multivariate analysis by Raizer et al, age, presence of extracranial metastasis, neurologic symptoms, and the number of brain metastases were significantly correlated with poorer median survival. Patients receiving surgery respectively stereotactic single-dose radiation therapy or temozolomide chemotherapy displayed more favorable survival rates [575]. In a series by the "Sydney Melanoma Unit", advanced age presented an unfavorable prognostic factor.…”

“…Systematic search of the literature de-novo: [573][574][575][576] Strength of consensus: 100 % 3.5.10.1.c Consensus-based recommendation GCP With acute signs and symptoms due to brain metastases, the possibility of surgery should be considered.…”

“…Surgery and stereotactic single-dose radiation therapy (radiosurgery) have shown enhanced local tumor control as well as increased median overall survival [573][574][575]577]. With respect to tumor control through local therapy (single-dose irradiation or surgery), there is conflicting data on the number of brain metastases in limited intracranial disease.…”

Long-term Complete Remission Following Radiosurgery and Immunotherapy in a Melanoma Patient with Brain Metastasis: Immunologic Correlates

“…Patients with melanoma brain metastases carry a very poor prognosis with a median overall survival of about 4 to 5 months (9).…”