Metastatic melanoma: Surgical treatment of brain metastases – Analysis of 110 patients

McHugh, F.; Kow, Chien Yew; Falkov, A.; Heppner, Peter; Law, Andrew; Bok, Ari P.L.; Schweder, Patrick

doi:10.1016/j.jocn.2019.12.063

Cited by 14 publications

(10 citation statements)

References 45 publications

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“…Also, this study confirmed the survival advantage given by a multimodal approach with locoregional and systemic therapies (median OS of 12.32 months, 95% CI: 7.91–25.29). Currently, no prospective data are available to support a combination modality, but our results are consistent with other retrospective cohorts reporting a median OS up to 7–18 months [5,13,36–38]. Conversely, in our cohort, WBRT alone was not associated with survival benefits compared to BSC, even if confounders related to SRS/neurosurgery eligibility might have influenced the outcome [39].…”

Section: Discussionsupporting

confidence: 89%

“…Historically, MBM diagnosis has been associated with a poor prognosis, with a median reported overall survival (OS) of 4-5 months [3]. Neurosurgery and stereotactic radiosurgery (SRS) represent valuable treatment options for patients with limited central nervous system (CNS) involvement, reaching a median OS of about 10 months [3][4][5]. Conversely, the use of chemotherapy in patients with MBM has not shown significant survival improvement.…”

Section: Introductionmentioning

confidence: 99%

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Estimating survival in patients with melanoma brain metastases: prognostic value of lactate dehydrogenase

Pelizzari¹,

Bertoli

Buriolla

et al. 2023

Melanoma Research

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Patients with melanoma brain metastases (MBM) have poor prognosis, albeit advances in locoregional and systemic treatments. The melanoma-specific Graded Prognostic Assessment (GPA) effectively stratifies survival for patients with MBM. Nevertheless, lactate dehydrogenase (LDH), a well known prognostic factor for patients with melanoma, is not represented in the GPA scores and might add prognostic information for patients with MBM. In this study, 150 consecutive patients with MBM were retrospectively analyzed with the aim of evaluating independent prognostic factors for MBM patients, including LDH. Furthermore, we implemented a disease-specific prognostic score and estimated survival according to treatment modalities. On the basis of multivariable Cox regression analyses, six prognostic factors (age, BRAF status, number of MBM, number of extracranial metastatic sites, performance status, and LDH level) resulted statistically significant in terms of survival and were combined in a prognostic score to stratify patients in distinct prognostic groups (P < 0.0001). Among treatment modalities, a multimodal approach with stereotactic radiosurgery or neurosurgery associated with systemic therapy showed the best outcome (median overall survival: 12.32 months, 95% confidence interval, 7.92–25.30). This is the first study to demonstrate that LDH has independent prognostic value for patients with MBM and might be used to improve prognostic stratification, albeit external validation is mandatory. Survival of patients with MBM is affected by both disease-specific risk factors and treatment modalities, with locoregional treatments associated with better outcomes.

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Section: Discussionsupporting

confidence: 89%

Section: Introductionmentioning

confidence: 99%

Estimating survival in patients with melanoma brain metastases: prognostic value of lactate dehydrogenase

Pelizzari¹,

Bertoli

Buriolla

et al. 2023

Melanoma Research

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“…In this context, most previous studies reporting outcome after surgery for BM must be put into perspective, since observed differences in survival have either been attributed to BM resection only, or mostly in comparison to, or as an adjunct to radiotherapy. 12,12,13,23 However, the impact of systemic treatment after surgery, as shown for example by Mc Hugh 24 -if indeed administered -has so far received little attention. Most frequently, the cause of death was also neglected.…”

Section: Discussionmentioning

confidence: 99%

Surgical resection of symptomatic brain metastases improves the clinical status and facilitates further treatment

et al. 2020

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“… 21 Survival has been positively correlated with EOR for both glioblastomas and brain metastases from melanoma. 3 , 4 Therefore, it is imperative to maximize EOR safely while preserving neurological function. To maximize EOR, brain shift must be accounted for accurately, especially in eloquent areas of the brain.…”

Section: Discussionmentioning

confidence: 99%

Use of virtual magnetic resonance imaging to compensate for brain shift during image-guided surgery: illustrative case

Kim

Etame

et al. 2022

Journal of Neurosurgery: Case Lessons

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BACKGROUND Maximal safe resection is the paramount objective in the surgical management of malignant brain tumors. It is facilitated through use of image-guided neuronavigation. Intraoperative image guidance systems use preoperative magnetic resonance imaging (MRI) as the navigational map. The accuracy of neuronavigation is limited by intraoperative brain shift and can become less accurate over the course of the procedure. Intraoperative MRI can compensate for dynamic brain shift but requires significant space and capital investment, often unavailable at many centers. OBSERVATIONS The authors described a case in which an image fusion algorithm was used in conjunction with an intraoperative computed tomography (CT) system to compensate for brain shift during resection of a brainstem hemorrhagic melanoma metastasis. Following initial debulking of the hemorrhagic metastasis, intraoperative CT was performed to ascertain extent of resection. An elastic image fusion (EIF) algorithm was used to create virtual MRI relative to both the intraoperative CT scan and preoperative MRI, which facilitated complete resection of the tumor while preserving critical brainstem anatomy. LESSONS EIF algorithms can be used with multimodal images (preoperative MRI and intraoperative CT) and create an updated virtual MRI data set to compensate for brain shift in neurosurgery and aid in maximum safe resection of malignant brain tumors.

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Metastatic melanoma: Surgical treatment of brain metastases – Analysis of 110 patients

Cited by 14 publications

References 45 publications

Estimating survival in patients with melanoma brain metastases: prognostic value of lactate dehydrogenase

Estimating survival in patients with melanoma brain metastases: prognostic value of lactate dehydrogenase

Surgical resection of symptomatic brain metastases improves the clinical status and facilitates further treatment

Use of virtual magnetic resonance imaging to compensate for brain shift during image-guided surgery: illustrative case

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