Purely Meningeal Intracranial Relapse of Melanoma Brain Metastases After Surgical Resection and Immunotherapy as a Unique Disease Progression Pattern: Our Experience and Review of the Literature

Armocida, Daniele; Marzetti, F; Pesce, Alessandro; Caporlingua, Alessandro; D’Angelo, Luca; Santoro, Antonio

doi:10.1016/j.wneu.2019.10.101

Cited by 14 publications

(6 citation statements)

References 24 publications

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“…Of note, 50% of patients treated with craniotomy had a recurrence of intracranial disease after surgical resection, with a majority (56.8%) progressing due to the development of new brain metastases. Others have reported a recurrence rate as high as 48-55% after surgical resection, which is similar to our observations [28].…”

Section: Discussionsupporting

confidence: 93%

Melanoma Brain Metastases in the Era of Targeted Therapy and Checkpoint Inhibitor Therapy

Rieth

Swami

Mott

et al. 2021

Cancers

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Brain metastases commonly develop in melanoma and are associated with poor overall survival of about five to nine months. Fortunately, new therapies, including immune checkpoint inhibitors and BRAF/MEK inhibitors, have been developed. The aim of this study was to identify outcomes of different treatment strategies in patients with melanoma brain metastases in the era of checkpoint inhibitors. Patients with brain metastases secondary to melanoma were identified at a single institution. Univariate and multivariable analyses were performed to identify baseline and treatment factors, which correlated with progression-free and overall survival. A total of 209 patients with melanoma brain metastases were identified. The median overall survival of the cohort was 5.3 months. On multivariable analysis, the presence of non-cranial metastatic disease, poor performance status (ECOG 2–4), whole-brain radiation therapy, and older age at diagnosis of brain metastasis were associated with poorer overall survival. Craniotomy (HR 0.66, 95% CI 0.45–0.97) and treatment with a CTLA-4 checkpoint inhibitor (HR 0.55, 95% CI 0.32–0.94) were the only interventions associated with improved overall survival. Further studies with novel agents are needed to extend lifespan in patients with brain metastases in melanoma.

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Section: Discussionsupporting

confidence: 93%

Melanoma Brain Metastases in the Era of Targeted Therapy and Checkpoint Inhibitor Therapy

Rieth

Swami

Mott

et al. 2021

Cancers

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“…We confirm with our study that patients defined as elderly (with an age above 65 years) have a higher rate of late non-operative complications, higher mortality, and this independently concerns the comorbidity present, on the grounds of the same low ASA class, without a further distinction of age (elderly and ultra-elderly >75 years) [ 6 , 7 , 8 , 9 ], and, in contrast to the literature [ 26 , 33 ] irrespective of the biological behavior of the tumor.…”

Section: Discussionsupporting

confidence: 88%

Intracranial Meningioma in Elderly Patients. Retrospective Multicentric Risk and Surgical Factors Study of Morbidity and Mortality

et al. 2022

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With the increasing life expectancy, a large number of intracranial meningiomas (IM) have been identified in elderly patients. There is no general consensus regarding the management for IMs nor studies regarding the outcome of older patients undergoing meningioma surgery. We aimed to determine whether preoperative variables and postoperative clinical outcomes differ between age groups after meningioma surgery. We analyzed data from all patients who had undergone IM surgery from our departments. The final cohort consisted of 340 patients affected by IM with ASA class I-II: 188 in the young group (<65) and 152 in the elderly. The two subgroups did not present significant differences concerning biological characteristics of tumor, localization, diameters, lesion and edema volumes and surgical radicality. Despite these comparable data, elderly presented with a significantly lower Karnofsky Performance status value on admission and remained consistently lower during the follow-up. We establish instead that there is no intrinsic correlation to the presence of IM and no significant increased risk of complications or recurrence in elderly patients, but rather only an increased risk of reduced performance status with mortality related to the comorbidity of the patient, primarily cardiovascular disease, and an intrinsic frailty of the aged population.

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“…The study by Narayan et al [ 28 ], which was until now the largest series with 80 cases of GIMs, demonstrated that regression analysis showed age, sex, location of the tumor [ 44 , 45 ], Simpson grade of excision, and histology of tumor were the factors that significantly affected the KPS, complications, and recurrence [ 39 , 46 ]. Our series confirms just some of these findings whereas the mortality rate, recurrence rate, Simpson grade, and KPS are comparable between the two groups, but there is a higher rate of complications in the first 30 days after the surgical procedure for GIMs compared with smaller meningiomas [ 47 , 48 , 49 , 50 ]. We identified a higher incidence of postoperative ischemia, infections, and seizure in the GIM group.…”

Section: Discussionsupporting

confidence: 84%

The Surgical Risk Factors of Giant Intracranial Meningiomas: A Multi-Centric Retrospective Analysis of Large Case Serie

et al. 2022

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Giant intracranial meningiomas (GIMs) are a subgroup of meningiomas with huge dimensions with a maximum diameter of more than 5 cm. The mechanisms by which a meningioma can grow to be defined as a “giant” are unknown, and the biological, radiological profile and the different outcomes are poorly investigated. We performed a multi-centric retrospective study of a series of surgically treated patients suffering from intracranial meningioma. All the patients were assigned on the grounds of the preoperative imaging to giant and medium/large meningioma groups with a cut-off of 5 cm. We investigated whether the presence of large diameter and peritumoral brain edema (PBE) on radiological diagnosis indicates different mortality rates, grading, characteristics, and outcomes in a multi-variate analysis. We found a higher risk of developing complications for GIMs (29.9% versus 14.8%; p < 0.01). The direct proportional relationship between PBE volume and tumor volume was present only in the medium/large group (Pearson correlation with p < 0.01) and not in the GIM group (p = 0.47). In conclusion, GIMs have a higher risk of developing complications in the postoperative phase than medium/large meningioma without higher risk of mortality and recurrence.

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Purely Meningeal Intracranial Relapse of Melanoma Brain Metastases After Surgical Resection and Immunotherapy as a Unique Disease Progression Pattern: Our Experience and Review of the Literature

Cited by 14 publications

References 24 publications

Melanoma Brain Metastases in the Era of Targeted Therapy and Checkpoint Inhibitor Therapy

Melanoma Brain Metastases in the Era of Targeted Therapy and Checkpoint Inhibitor Therapy

Intracranial Meningioma in Elderly Patients. Retrospective Multicentric Risk and Surgical Factors Study of Morbidity and Mortality

The Surgical Risk Factors of Giant Intracranial Meningiomas: A Multi-Centric Retrospective Analysis of Large Case Serie

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