Number of metastases, serum lactate dehydrogenase level, and type of treatment are prognostic factors in patients with brain metastases of malignant melanoma

Abstract

; on behalf of the Dermatologic Cooperative Oncology Group and the National Interdisciplinary Working Group on Melanoma BACKGROUND: This multicenter study aimed to identify prognostic factors in patients with brain metastases from malignant melanoma (BM-MM). METHODS: In a retrospective survey in 9 cancer centers of the German Cancer Society, 692 patients were identified with BM-MM during the period 1986 through 2007. Overall survival was analyzed using a Kaplan-Meier estimator and compared with log-rank analysis. Cox proportional hazards models were used to identify prognostic factors significant for survival. RESULTS: The median overall survival of the entire cohort was 5.0 months (95% confidence interval [95% CI], 4 months-5 months). Significant prognostic factors in the univariate Kaplan-Meier analysis were Karnofsky performance status (70% vs <70%; P < .001), number of BM-MM (single vs multiple; P < .001), pretreatment levels of lactate dehydrogenase (LDH) (normal vs elevated; P < .001) and S-100 (normal vs elevated; P < .001), prognostic groups according to Radiation Therapy Oncology Group (class I vs class II vs class III; P ¼ .0485), and treatment choice (for the cohort with single BM-MM only) (stereotactic radiotherapy or neurosurgical metastasectomy vs others; P ¼ .036). Cox proportional hazards models revealed pretreatment elevated level of serum LDH (hazard ratio [HR], 1.6; 95% CI, 1.3-2.0 [P ¼ .00013]) and number of BM-MM (HR, 1.6; 95% CI, 1.3-2.0 [P ¼ .00011]) to be independent prognostic variables in the entire cohort, whereas in patients with a single BM-MM, treatment choice (HR, 1.5; 95% CI, 1.1-1.9 [P ¼ .0061]) was identified as a unique prognostic factor. CONCLU-SIONS: The overall survival of patients with BM-MM primarily depends on the number of metastases and pretreatment level of LDH. In the case of a single brain metastasis, stereotactic radiotherapy or neurosurgical metastasectomy is by far the most important factor for improving survival.

The effectiveness of brain metastases radiotherapy in patients with melanoma

“…Table VI presents the values of average survival periods of patients with MBM depending on the KPS score, which were 5.9-6.3 months for KPS ≥ 70 and were definitely lower in patients with a poorer general performance (KPS < 70), where they varied from 1.8 to 3.8 months. The results based on the site's material are comparable with those presented with other authors [5,13,14,37,40,46]. The other, generally accepted prognostic factor is the number of MBM foci.…”

“…In this case also the site's experience was compared with the results published by other authors [1,5,13,14,37,40,46]. Some investigators point to the adverse prognostics significance of the presence of metastases outside the brain, in particular in the lungs, liver, spleen and adrenal glands, and, to a lesser degree, in the bones, lymph nodes and skin [5,6,8,30,31,[33][34][35][40][41][42]. In the site's own material, in a single-variance analysis, it was shown that the co-existence of the metastases in extracranial locations was an adverse prognostic factor, which was, however, not confirmed by the results of the multivariance analysis.…”

“…Melanoma gives rise to 7-13% of all brain metastases (MBM -melanoma brain metastases) and is ranked as third leading cause of brain metastases, after lung cancer (30-60%) and breast cancer (15-25%) [1][2][3][4][5][6][7][8]. The prevalence of melanoma brain metastases in patients with locoregional advancement melanoma is about 10%, whereas in patients with a generalised stage of the disease, it exceeds 15-46% [1,2,4,6,8].…”

“…The prevalence of melanoma brain metastases in patients with locoregional advancement melanoma is about 10%, whereas in patients with a generalised stage of the disease, it exceeds 15-46% [1,2,4,6,8]. In almost half of the patients with melanoma, MBM is the cause of death, whilst autopsies shows the presence of MBM in 50-75% of such melanoma cases [1,2,4,5,[8][9][10][11].…”

Vemurafenib in the treatment of brain metastases from melanoma

“…До недавнего времени прогноз пациентов с диссеминирован-ной меланомой, имеющих метастатическое поражение головного мозга, оставался крайне неблагоприятным с медианой продолжи-тельности жизни, не превышающей 2-4 мес [9,10]. Следует от-метить, что недостаточное количество результатов рандомизиро-ванных исследований, обусловленное сложностями набора одно-родных групп больных, не позволяет говорить об общепринятых стандартах лечения.…”