Brain metastasis from melanoma: the prognostic value of varying sites of extracranial disease

Abstract

Patients with brain metastasis from melanoma have poor outcomes. Radiation is used both for prognostic and symptomatic value. We aimed to further clarify the role of stereotactic radiosurgery (SRS) and whole brain radiotherapy (WBRT) as well as the prognostic implication of various sites of extracranial disease. The records of 73 consecutive patients treated at the University of Rochester Medical Center for brain-metastatic melanoma from January 2004 to October 2013 were reviewed. The median overall survival (OS) was 3.0 months. Patients treated with WBRT alone had decreased OS compared to those treated with SRS alone (HR = 0.38, p = 0.001) or WBRT and SRS (HR = 0.51, p = 0.039). The mean number of brain metastasis differed (p = 0.002) in patients in patients who received WBRT (4.0) compared to those who did not (2.0). Among patients with extracranial disease (n = 63), bone metastasis (HR = 1.86, p = 0.047, n = 15) was a negative prognostic factor; liver (HR = 1.59, p = 0.113, n = 17), lung (HR = 1.51, p = 0.23, n = 51) and adrenal metastasis (HR = 1.70, p = 0.15, n = 10) were not. In patients with concurrent brain and lung metastasis, those with disease limited to those two sites (OS = 8.7 mo, n = 13) had improved OS (HR = 0.44, p = 0.014) compared to those with additional disease (OS = 1.8 mo, n = 50). Based on this hypothesis-generating retrospective analysis, SRS may offer survival benefit compared to WBRT alone in patients with brain metastatic melanoma. Bone metastasis appears to confer a particularly poor prognosis. Those with disease confined to the lung and brain may represent a population with improved prognosis.

Impact of clinical trial participation on survival in patients with castration-resistant prostate cancer: A multi-center analysis

“…Another selection bias arises from the effect of protocol eligibility criteria [12]. Most CTs included in our study strictly prohibited enrollment of patients with advanced disease, such as those with brain metastasis, an adverse prognostic factor for several cancers [18][19][20]. However, the two study groups had comparable proportions of metastatic location and burden, corroborating our hypothesis.…”

Systematic literature review and meta-analysis of clinical outcomes and prognostic factors for melanoma brain metastases

“…The HRs for each prognostic factor extracted from 31 observational studies are summarized in Table S9 , meta-HR are summarized in Table 3 , and forest plots provided in Figures S7–S15 ( 1 , 27 , 47 , 48 , 50 , 64 – 89 ). Meta-analysis suggested elevated lactate dehydrogenase (LDH) levels, male gender, BRAF wild-type, increased number of intracranial metastases, presence of active extracranial metastases, lower Karnofsky Performance Scale (KPS), and larger MBM volume were significantly associated with worse prognosis in patients with MBM.…”

Narrative review of palliative hypofractionated radiotherapy for high grade glioma

“…Finally, a prospective study of patients (median KPS 70) reported similar survival for a 60 Gy 6-week and 40-Gy 3-week course with less steroid dependency associated with HRT (68). The same group then showed equivalence in survival and QoL between 25 Gy/5 fractions and 40 Gy/15 fractions for elderly and/or frail patients (91).…”