Value of radiation therapy in the management of patients with cerebral metastases from malignant melanoma. Radiation therapy oncology group brain metastases study I and II

Abstract

Sixty patients from two Radiation Therapy Oncology Group (RTOG) studies with cerebral metastases from malignant melanoma were analyzed to determine the response to whole brain irradiation. General performance status, neurologic function, and specific neurologic symptoms were evaluated for rate and duration of improvement. Also analyzed was the influence of chemotherapy and steroids, although neither was a controlled factor. Results indicate a significant benefit from radiation therapy in terms of symptomatic and neurologic function improvement. Symptomatic improvement was observed in 76%, with 31% completely improved. Of the four most frequent symptoms, complete or partial improvement was observed as follows: headache--27 of 37 patients (73%); motor loss--14 of 23 patients (61%); impaired mentation--13 of 24 patients (62%); and convulsions--10 of 12 patients (83%). Improvement in neurologic function class was observed in 18 of 44 patients (41%). Median survival for Study 1 patients was 10 weeks (range 1-200) and that of Study II patients 14 weeks (range 1-76). These results are comparable to those found in radiation therapy of brain metastases from all other primary tumors.

A prognostic index that predicts outcome following palliative whole brain radiotherapy for patients with metastatic malignant melanoma

“…The symptomatic benefit of WBRT has been studied, and separating the relative benefits of steroids and radiotherapy is difficult. If patients survive long enough, they will obtain a symptomatic benefit from WBRT in up to 76% of cases (Carella et al, 1980). Our aim with this review was to identify factors predicting a poor outcome and to help identify those who are unlikely to survive long enough to see a palliative benefit.…”

“…Whole brain radiotherapy is commonly used for palliation for patients with large or multiple metastases. It has been shown to provide symptomatic improvement in 76% of patients (Carella et al, 1980). It is most commonly combined with corticosteroid therapy, which is discontinued on completion of WBRT and resolution of symptoms.…”

Malignant melanoma brain metastases: Treatment results and prognostic factors - a single-center retrospective study

“…There are data from randomized trials comparing wholebrain radiotherapy (WBRT) and chemotherapy in patients with melanoma metastatic to the brain where treatment decision depends on clinical factors such as size, location, number of metastases, disease extent but also performance status and the age of the patients (20)(21)(22). Treatment approaches to metastatic malignant melanoma include systemic therapy (23,24) as well as local treatment such as stereotactic radiotherapy (25) and surgery (26,27) for patients with solitary brain metastasis and absent or stable extracranial disease (28).…”

“…Treatment approaches to metastatic malignant melanoma include systemic therapy (23,24) as well as local treatment such as stereotactic radiotherapy (25) and surgery (26,27) for patients with solitary brain metastasis and absent or stable extracranial disease (28). Patients with inoperable or multiple brain metastases may be candidates for WBRT (29) which is also part of the multimodal treatment concept of metastatic malignant melanoma (21,30,31) with an expected median survival of 2.5-4 months after hypofractionated radiotherapy (32) as opposed to steroid therapy alone (33,34). however, both the treatment sequence and the decision for a validated standard approach of combined therapy in metastasized melanoma can be challenging (35,36).…”

Diagnosis and Treatment Options for Brain Metastasis of Melanoma

“…However, a review of several retrospective series has revealed that no scheme is better than the current standard of 30 Gy in 10 fractions [38]. Improved clinical outcomes may occur after WBRT, showing mildly increased median survival times to about 2.0 to 6.1 months [79][80][81][82]. When patients are stratified according to the RTOG recursive partitioning analysis (RPA), the effect of WBRT can be better extrapolated.…”