Surgical treatment of brain metastases in malignant melanoma

Brega, Kerry E.; Robinson, William A.; Winston, Ken R.; Wittenberg, Wayne

doi:10.1002/1097-0142(19901115)66:10<2105::aid-cncr2820661011>3.0.co;2-i

Cited by 111 publications

(47 citation statements)

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“…Some studies have shown promising results with median survivals of 5-10 months, although in most of these studies patients presented with solitary metastasis (Madajewicz et al, 1984;Brega et al, 1990;Stevens et al, 1992). Our study suggests an improved survival time, but the results did not reach statistical significance.…”

Section: Discussioncontrasting

confidence: 76%

“…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.…”

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confidence: 99%

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Cerebral metastases of cutaneous melanoma

Gupta

Ag²,

Rm³

1997

Br J Cancer

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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...

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Section: Discussioncontrasting

confidence: 76%

mentioning

confidence: 99%

Cerebral metastases of cutaneous melanoma

Gupta

Ag²,

Rm³

1997

Br J Cancer

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“…Surgical resection, usually followed by radiotherapy, has been employed to treat brain metastases in selected patients (usually with solitary, superficial lesions). 12,13 Extended survival can be achieved in patients with high performance status or Radiation Therapy Oncology Group (RTOG) Recursive Partition Analysis (RPA) Class I (Karnofsky Performance Status [KPS] !70%, primary site controlled, <65 years old, and no evidence of systemic metastases outside the brain). 1,9,13,14 Because multiple, rather than solitary, brain metastases are believed to be more common in melanoma, 2 the majority of patients with melanoma brain metastases are not considered surgical candidates.…”

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confidence: 99%

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

Samlowski

Watson

Wang

et al. 2007

Cancer

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BACKGROUND.Brain metastases are a frequent complication in advanced melanoma. A 3.6 to 4.1‐month median survival has been reported after treatment with whole brain radiotherapy. We performed a retrospective analysis of our institutional experience of multimodality treatment utilizing linear accelerator (Linac)‐based stereotactic radiosurgery (SRS).METHODS.Forty‐four melanoma patients with brain metastases underwent 66 SRS treatments for 156 metastatic foci between 1999 and 2004. Patients were treated with initial SRS if ≤5 brain metastases were present. All patients had Karnofsky Performance Status (KPS) ≥70, but 37 patients had active systemic metastases (Recursive Partition Analysis Class 2). Survival was calculated from the time of diagnosis of brain metastases. Minimum follow‐up was 1 year after SRS. The potential role of prognostic factors on survival was evaluated including age, sex, interval from initial diagnosis to brain metastases, surgical resection, addition of whole brain radiotherapy (WBRT), number of initial metastases treated, and number of SRS treatments using Cox univariate analysis.RESULTS.The median survival of melanoma patients with brain metastases was 11.1 months (95% confidence interval [CI]: 8.2–14.9 months) from diagnosis. One‐year and 2‐year survivals were 47.7% and 17.7%, respectively. There was no apparent effect of age or sex. Surgery or multiple stereotactic radiotherapy treatments were associated with prolonged survival. Addition of WBRT to maintain control of brain metastases in a subset of patients did not improve survival.CONCLUSIONS.Our results suggest that aggressive treatment of patients with up to 5 melanoma brain metastases including SRS appears to prolong survival. Subsequent chemotherapy or immunotherapy after SRS may have contributed to the observed outcome. Cancer 2007. © 2007 American Cancer Society.

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“…These risks continue to gradually improve with the advancement of available procedures and tools, as was seen with the utilization of CT and MRI neuroimaging. Several recent studies have shown the risk of mortality to be between 0 to 14.2 percent during the postoperative period [14,18,86,87] which is compared to earlier reports of mortality in up to 22 percent of patients [87]. Given the limited survival time of patients harboring metastatic melanoma of the brain, postoperative neurological deficits and prolonged recovery times are best avoided if possible.…”

Section: Surgical Resectionmentioning

confidence: 91%

“…Generally, these nonfocal or focal complaints can present in up 75 percent of patients with brain metastases, whereas the incidence of seizures in patients may be as high 50 percent [6,14,29]. Although patients with metastases of melanoma to the brain can present with a range of signs and symptoms, there are still a number of patients who may have few or no obvious indications of an underlying pathology [14,29]. This may be due insufficient mass effect, however their growth rate compared to primary brain tumors is notably faster.…”

Section: Clinical Findingsmentioning

confidence: 99%