Cerebral metastases of cutaneous melanoma

Abstract

Summary Cerebral metastases of cutaneous melanoma carry a very poor prognosis. We report our experience of 31 patients who presented with cerebral metastasis of cutaneous melanoma in a 5-year period between mid-1991 and mid-1996. Cerebral metastases were diagnosed on computerized tomography (CT) scan after patients became symptomatic. The overall median survival in our series was 4 months. Seventeen patients (55%) received treatment with radiotherapy and dexamethasone with resolution of their symptoms, although median survival remained at 4 months. Six patients (19%) had surgery followed by whole brain radiotherapy, with median survival of 5 months. The remaining eight patients received dexamethasone alone. Data from patients surviving less than 2 months and over 6 months suggest that the poor prognostic factors are the presence of more than one cerebral metastasis and additional extracranial metastases.Keywords: cerebral metastasis; malignant melanoma; radiotherapy Cutaneous malignant melanoma is the third most common cause of cerebral metastases after breast and lung (Zimm et al, 1981). The prevalence of cerebral metastases in patients with metastatic malignant melanoma, as detected by computerized tomography (CT) and magnetic resonance (MR), has been reported at approximately 20% (Retsas, 1988).Cerebral metastases from malignant melanoma carry a poor prognosis. In untreated cases, median survival is only a few weeks (Amer et al, 1978) rising to 3-4 months in treated cases (Gottlieb et al, 1972;Amer et al, 1978;Carella et al, 1980;Zimm et al, 1981;Retsas, 1988). Various therapeutic measures have been assessed including chemotherapy with agents such as cisplatin (Feun et al, 1990), fotemustine (Merimsky et al, 1991), lomustine (Retsas, 1988) and a combination of dacarbazine and fotemustine (Merimsky et al, 1992;Chang et al, 1994). Radiotherapy (Zimm et al, 1981;Retsas, 1988) and surgery (Zimm et al, 1981;Brega et al, 1990) have also been evaluated. However, in general, the effect on mortality with all modalities of treatment has been disappointing.We report the clinical features, management and outcome of all patients presenting to the departments of Dermatology and Oncology, University of Glasgow, Western Infirmary, Glasgow, with cerebral metastasis from malignant melanoma over a 5-year period. METHODSThirty-one patients presenting between mid-1991 and mid-1996 with melanoma and cerebral metastasis confirmed by CT scan were identified. Data obtained included age, sex, site and thickness of primary tumour, time interval between primary tumour and cerebral metastasis, distribution of metastases, treatment given and outcome. Symptoms before CT scan and 1 month after diagnosis were evaluated and recorded as follows; symptoms resolved, remained static or worsened.Received 29 October 1996 Revised 2 January 1997 Accepted 6 January 1997 Correspondence to: G Gupta Patients received either no treatment or a course of radiotherapy with or without surgery. Radiotherapy was given to the whole brain with X-rays which wer...

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

“…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.…”

“…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).…”

Dose Escalation of Whole-Brain Radiotherapy for Brain Metastases From Melanoma

“…These results are consistent with the data from the literature. The prognostic relevance of these three prognostic factors has been described before in patients with brain metastases from melanoma (2,3,6,8). In addition, KPS has been suggested as a relevant prognostic factor for OS (3).…”

Malignant melanoma brain metastases: Treatment results and prognostic factors - a single-center retrospective study

“…Treatment approaches to metastatic malignant melanoma include systemic therapy (23,24) as well as local treatment such as stereotactic radiotherapy (25) and surgery (26,27) for patients with solitary brain metastasis and absent or stable extracranial disease (28). Patients with inoperable or multiple brain metastases may be candidates for WBRT (29) which is also part of the multimodal treatment concept of metastatic malignant melanoma (21,30,31) with an expected median survival of 2.5-4 months after hypofractionated radiotherapy (32) as opposed to steroid therapy alone (33,34). however, both the treatment sequence and the decision for a validated standard approach of combined therapy in metastasized melanoma can be challenging (35,36).…”