The treatment of brain metastases in melanoma patients

Bafaloukos, Dimitrios; Gogas, Helen

doi:10.1016/j.ctrv.2004.05.001

Cited by 142 publications

(81 citation statements)

References 31 publications

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“…Melanoma is the malignancy with the highest rate of brain metastasis, which occurs in more than 50% of patients with advanced melanoma (73). Intracranial disease progression is the cause of death in 20-54% of patients with disseminated melanoma (74).…”

Section: Role Of Palliative Rt For Melanomasmentioning

confidence: 99%

Radiation Therapy for Melanoma

Shi

2017

Cutaneous Melanoma: Etiology and Therapy

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Although melanoma is a relative radioresistant tumor, radiation therapy (RT) remains a valid and effective treatment option for the management of melanoma. RT as a primary treatment is often offered in well-defined situations, such as medical inoperability, lentiginous melanoma, mucosal melanoma, and ocular melanoma. Adjuvant RT following lymphadenectomy in node-positive melanoma patients prevents local and regional recurrence; however, the role of adjuvant RT remains controversial and underutilized due to lack of overall survival benefit. On the other hand, RT is highly effective in providing symptom palliation for metastatic melanoma and is widely used. Advanced RT technologies such as stereotactic radiosurgery (SRS) and stereotactic body radiotherapy (SBRT) can achieve excellent local control with minimum toxicities. They are commonly used in the management of brain, lung, spine, and liver metastases. Most recently, it is under active investigation on combining RT with new systemic options, such as targeted therapy, or immunotherapy. The advancements in the treatment of patients with melanoma highlight the importance of multidisciplinary management in this disease. Radiation therapy will continue to be one of the key therapeutic options.

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Section: Role Of Palliative Rt For Melanomasmentioning

confidence: 99%

Radiation Therapy for Melanoma

Shi

2017

Cutaneous Melanoma: Etiology and Therapy

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“…Brain metastases of a primary melanoma are associated with the highest risk of death [1]. No treatments were demonstrated to be useful.…”

Section: Introductionmentioning

confidence: 99%

Dynamic Changes of Molecular Markers during Natural History in Metastatic Melanoma: Ethical Issues and Lessons to Learn

Eugeniu¹,

Zaharie²,

Serban³

et al. 2016

J Integr Oncol

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Objective: Malignant melanoma with brain metastases is associated with a higher risk of death. No specific treatments were demonstrated to be useful in a such situation. Drugs as temozolomide orally or new targeted treatments showed significant objective response rates, even complete regression. Such responses could be obtained using new strategies based on dynamic changes over time of some molecular markers. Elements of ethics should be taken into account in order to adapt treatment and avoid resistance. Methods:The case of a 59-year old male with a primary cutaneous melanoma of the trunk, treated at Cancer Institute "Ion Chiricuta" from August 2001 is presented. After multiple loco-regional relapses, the patient developed brain metastases and started temozolomide 150 mg once daily, five days, every 4 weeks, 6 cycles with concurrent whole brain external radiotherapy. Comparative immunostaining including proliferation and pro-apoptotic molecular markers between the initial diagnosis (2001), before (2005) and after (2008) temozolomide treatment was performed.Result: Nine months after the start of temozolomide treatment, complete response was confirmed by magnetic resonance imaging. Overall cancer specific survival was 41 months. Ki-67, cyclin E, HMB-45 expression and Bax/ Bcl-2 ratio increased during almost 10 years of treatment and follow-up. Bcl-2 staining was absent at the last analysis. Only p53 and Bax expression doesn't changed during treatment. Conclusion:It seems that metastatic melanoma cells lost some of pro-apoptotic markers and overexpressed markers of proliferation. Predictive markers of response and resistance were actively identified; their combination and dynamic over time could help the oncologist to select those metastatic patients with highest chances of response. Dynamic changes of these molecular markers would guide treatment and the overall core strategy. Serial biopsies and tissue analyses become a challenging ethical issue. Empiric treatments based on a unique tumor signature should be modified using an adaptive approach.

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“…The prognosis of patients with MBM is poor with a mean survival of 3-6 months; in patients treated solely with corticosteroids, the mean survival is 2 months, whilst after the whole brain radiotherapy (WBRT) -it is about 3-4 months [6,8,10,[12][13][14][15][16]. Numerous publication data suggests that some patients may benefit from surgical treatment or radio-surgery (with the application of stereotactic methods of radiotherapy -SBRT), where the survival period varies between a few months and more than one year (12 months).…”

Section: Introductionmentioning

confidence: 99%

“…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].…”

Section: Introductionmentioning

confidence: 99%

The effectiveness of brain metastases radiotherapy in patients with melanoma

Szyszka-Charewicz

2017

Nowotwory. Journal of Oncology

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Introduction. Melanoma gives rise to 7-13% brain metastases (MBM -melanoma brain metastases) and is ranked third leading cause of brain metastases. The prognosis of patients with MBM is poor, with a median survival time of 3-6 months. Assessment of the value and limitations of three prognostic scores used in patients with melanoma brain metastases (MBM) was presented in this paper. Material and methods. In 110 patients with MBM, we executed an analysis of prognostic factors. All patients were treated with radiotherapy: whole brain radiotherapy performed as a treatment method in combination with chemotherapy (14 patients -12.7%), neurosurgery (12 patients -10.9% or stereotactic radiosurgery (8 patients -7.3%). Results. The median overall survival (OS) from diagnosis MBM was 4.8 months (95% CI 4.1-5.2 months). The analyses showed that the Karnofsky Performance Status and number of the MBM are independent significant prognostic factors. The analyses of OS, as a function of prognostic scores, showed that in the class with the best prognosis median OS was similar (7.2-10.7 months); and in the class with the worse prognosis median OS was also similar (range, 2.6-4.3 months). Conclusions. Our observations and data from literature showed that the presented scores can: distinguish classes of patients by prognosis before treatment, guide the choice of treatment methods and help design strategies for patient selection in clinical trials but they did not fully discriminate between unfavourable groups. NOWOTWORY J Oncol 2016; 66, 5: 367-374

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The treatment of brain metastases in melanoma patients

Cited by 142 publications

References 31 publications

Radiation Therapy for Melanoma

Radiation Therapy for Melanoma

Dynamic Changes of Molecular Markers during Natural History in Metastatic Melanoma: Ethical Issues and Lessons to Learn

The effectiveness of brain metastases radiotherapy in patients with melanoma

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