Brain metastases from malignant melanoma: Conventional vs. high-dose-per-fraction radiotherapy

Ziegler, James; Cooper, Jay S.

doi:10.1016/0360-3016(86)90327-5

Cited by 62 publications

(22 citation statements)

References 13 publications

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“…The median overall survival of approximately 7 weeks is similar to that quoted by other authors who have reported median survivals of between 9 and 20 weeks (Madajewicz et al, 1984;Choi et al, 1985;Ziegler and Cooper, 1986;Barth et al, 1995;Gupta et al, 1997;Ellerhorst et al, 2001). Clearly, in a situation with such a poor prognosis, it is important to attempt to deliver treatment according to rational guidelines based on the likelihood of gaining a palliative benefit.…”

Section: Discussionsupporting

confidence: 83%

“…The largest reported series of WBRT in MMM is by Sampson et al (1998) who treated 180 patients with a median survival of 120 days. Other smaller series report similar median survivals in the range of 9 -20 weeks (Madajewicz et al, 1984;Choi et al, 1985;Ziegler and Cooper, 1986;Barth et al, 1995;Gupta et al, 1997;Ellerhorst et al, 2001). Numerous studies of the effects of fraction size on palliation and survival have failed to demonstrate a survival advantage and many authors recommend a total dose of at least 30 Gy (Ellerhorst et al, 2001).…”

mentioning

confidence: 92%

“…Many studies show improved survival in those undergoing resection and also in those with no extracranial metastases (Katz 1981;Madajewicz et al, 1984;Choi et al, 1985;Ziegler and Cooper 1986;Skibber et al, 1996;Ellerhorst et al, 2001). A series of 91 patients undergoing surgical resection of MMM brain metastases showed that the outcome was better if the patient had no neurological deficit, a single supratentorial site and no lung or visceral metastases.…”

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confidence: 99%

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A prognostic index that predicts outcome following palliative whole brain radiotherapy for patients with metastatic malignant melanoma

et al. 2004

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To determine the outcome of patients with metastatic malignant melanoma (MMM) treated with palliative whole brain radiotherapy (WBRT) and to identify factors that predict treatment outcome to assist future trial design, a retrospective study was performed on patients with MMM who received WBRT at the Royal Marsden Hospital between 1998 and 2003. Data regarding patient factors, tumour factors and survival were collected. A total of 112 patients were identified and full data were available for 102 patients. The median age was 53 years (range 25 -81 years), 66.7% were male and 33.3% female. The median dose prescribed was 20 Gy in five fractions as a mid-plane dose. The median survival after WBRT for the whole group was 51 days (range 3 -1386). In an attempt to define prognostic groups, we used the validated RTOG recursive partitioning analysis (RPA) classification for brain metastasis (class 1: Karnofsky Performance Score (KPS) X70%, age o65 years with no extracranial metastasis; class 3: KPS o70%; class 2: all others). The median survivals were 151, 71 and 21 days for RPA class 1, 2 and 3, respectively (Po0.001). Multivariate analysis showed that RPA class, leptomeningeal involvement, presence and number of extracranial metastatic sites and progressive disease in the brain on imaging before WBRT are important independent predictive factors. A prognostic index was derived from these factors that allowed identification of patients unlikely to benefit from WBRT. In conclusion, the RTOG RPA classification is valid when applied to patients with MMM. Patients in RPA class 1 and good prognosis class 2 are likely to benefit from palliative WBRT and should be considered for entry into trials that aim to improve duration of response. We identified that patients with RPA class 3, leptomeningeal involvement or RPA class 2 with poor prognostic index are unlikely to benefit from palliative WBRT.

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Section: Discussionsupporting

confidence: 83%

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confidence: 92%

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confidence: 99%

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A prognostic index that predicts outcome following palliative whole brain radiotherapy for patients with metastatic malignant melanoma

et al. 2004

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“…In der Literatur liegen die Remissionsraten bei 8 bis 59% [25,30], und Literaturangaben zufolge leben 40% bei UICC III mehr als ein Jahr, manche über fünf Jahre [5,6]. [21], neurologische Symptomatik [11], extrakranieller Befall [11,34,37], Metastasenzahl [34], Ausmaß der Resektion [11,12,21,22,28,34,37], objektive radiologische Remission [29], Einzeldosis [21,35] und Behandlungsdauer [11,12] von Bedeutung; die beiden letzten Faktoren sind umstritten. Die besten Ergebnisse erzielen Patienten mit solitären, asymptomatischen Metastasen ohne extrakraniellen Befall [11,12,16]; hier sind die chirurgische Resektion vor Radiotherapie [6,18,26,28] oder die alleinige stereotaktische Radiotherapie [16] die Therapie der Wahl.…”

Section: Patienten-und Tumorparameterunclassified

Lokal rezidiviertes und metastasiertes malignes Melanom Langzeitergebnisse und Prognosefaktoren nach perkutaner Radiotherapie

Keilholz

Pieritz

et al. 1999

Strahlenther Onkol

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“…Various protocols of fractionated radiation therapy, chemotherapy, and immunotherapy have been used, alone or after surgical resection. Despite these efforts, the prognosis for patients with single or multiple melanoma brain metastases remains poor, and the most common cause of death in patients with disseminated melanoma is intracranial metastases [4], with a median survival of 2-5 months [2,[5][6][7][8][9].…”

Section: Introductionmentioning

confidence: 99%

Linac Radiosurgery for Brain Metastasis of Melanoma

Noël

Simon

Valéry

et al. 2002

Stereotact Funct Neurosurg

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Purpose: To evaluate the efficacy and toxicity of stereotactic radiotherapy in the treatment of brain metastases of melanoma. Patients and Methods: From 1994 to 2001, 25 patients presenting with 61 metastases of cutaneous melanoma were treated with radiosurgery. Median age was 47 years (range: 25–73 years) and median Karnofski performance status 80 (range: 50–100). Twenty patients had one radiosurgery, 5 had two or three. Median metastasis diameter was 21 mm (range: 6–54.4 mm), and median metastasis volume was 1.7 cm³ (range: 0.4–25.6 cm³). Irradiation was delivered by a linear accelerator. Median minimal dose was 14.1 Gy (range: 10–19.4 Gy), and median maximal dose was 20.5 Gy (range: 16–48 Gy). Results: Mean follow-up was 12.6 months (range: 1–85 months). Five metastases progressed (9.8%), 2–12 months after radiosurgery. Three-, 6- and 12-month local control rates were 95 ± 3, 90 ± 5 and 84 ± 7%, respectively. By univariate analysis, only absence of extracranial tumor was a prognostic factor of local control. Three-, 6- and 12-month brain-disease-free survival rates were 75 ± 9, 68 ± 11 and 38 ± 13%, respectively. According to univariate analysis, only the Score Index for Radiosurgery in brain metastases (SIR) was a prognostic factor of brain-event-free survival (p = 0.03). Median survival was 8 months. Three-, 6- and 12-month overall survival rates were 75 ± 9, 53 ± 10, and 29 ± 10%, respectively. According to univariate analysis, extracranial controlled disease status (p = 0.03), and SIR (p = 0.04) were prognostic factors for overall survival. According to multivariate analysis, none was an independent prognosticator for overall survival. Complications were minimal. Conclusion: Radiosurgical treatment of brain metastases of melanoma is effective and accurate. The use of radiosurgery alone is an appropriate management strategy for many patients with brain metastases of melanoma.

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Brain metastases from malignant melanoma: Conventional vs. high-dose-per-fraction radiotherapy

Cited by 62 publications

References 13 publications

A prognostic index that predicts outcome following palliative whole brain radiotherapy for patients with metastatic malignant melanoma

A prognostic index that predicts outcome following palliative whole brain radiotherapy for patients with metastatic malignant melanoma

Lokal rezidiviertes und metastasiertes malignes Melanom Langzeitergebnisse und Prognosefaktoren nach perkutaner Radiotherapie

Linac Radiosurgery for Brain Metastasis of Melanoma

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