Linac Radiosurgery for Brain Metastasis of Melanoma

Abstract

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.

Radiosurgery for the Treatment of Spinal Melanoma Metastases

“…Over the past decade, radiosurgery has been demonstrated to be an effective treatment modality for patients with melanoma metastases to the brain [2,3,13,15,[30][31][32][33][34] . Given the poor local control associated with conventional external beam irradiation as well as their relative vascularity that leads to more diffi cult open surgical intervention, this study was intended to answer the question whether or not single-fraction radiosurgery would be equally effi cacious for melanoma metastases to the spine.…”

“…The dose was prescribed to the 80% isodose line, which covered the planning treatment volume in all cases. Tumor volume ranged from 4.1 to 153 cm 3 ). There were no complications associated with the fi ducial placement in this series.…”

“…The treatment plans were designed to treat the tumor with a prescribed dose of 18 Gy that was calculated to the 80% isodose line; the maximum tumor dose was 22.5 Gy. For the T3 lesion, the tumor volume was 16.8 cm 3 and the spinal cord received a maximum dose of 10 Gy. For the L2 lesion, the tumor volume was 46.5 cm 3 and the cauda equina received a maximum dose of 10 Gy.…”

“…Several clinical studies have described a signifi cant benefi t of stereotactic radiosurgery for the treatment of brain metastases specifi cally from melanoma over conventional whole-brain fractionated external beam radiotherapy [2,3,13,15,[30][31][32][33][34] . Other researchers have also shown the feasibility and clinical effi cacy of hypofractionated stereotactic body radiotherapy for spinal metastases [21,[23][24][25][26][27][28][29][35][36][37] .…”

Multimodality treatment of melanoma brain metastases incorporating stereotactic radiosurgery (SRS)

“…[18][19][20][21][22][23][24][25][26][27][28][29][30] In these studies SRS has generally been limited to patients with 1 to 3 metastases, with rare series accepting patients with larger numbers of lesions. 31 We report our encouraging institutional experience, based on expanded eligibility for Linac-based SRS for patients with up to 5 brain metastases, followed by planned systemic therapy.…”