Radiosurgery without whole brain radiotherapy in melanoma brain metastases

Grob, Jean-Jacques; Régis, Jean; Laurans, Renaud; Delaunay, M; Wolkenstein, P.; Paul, Karen; Souteyrand, P; Koeppel, M.C.; Murraciole, X.; Perragut, J.C.; Bonerandi, J. J.

doi:10.1016/s0959-8049(98)00026-4

Cited by 79 publications

(47 citation statements)

References 17 publications

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“…Similar to prior studies, this study is retrospective (37)(38)(39) which underlines the need for confirmation of our findings in prospective randomized trials.…”

Section: Discussionsupporting

confidence: 86%

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

Ostheimer

Bormann

Fiedler

et al. 2015

International Journal of Oncology

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Abstract. The brain is one of the most frequent locations of metastasis in malignant melanoma. We aimed to identify prognostic factors for overall survival (OS) and local tumor control (LC) in patients with malignant melanoma metastasized to the brain treated by multimodal therapy. All patients diagnosed with malignant melanoma brain metastases between 1992 and 2011 at a single center were registered (n=100, 65% male, 35% female). OS and LC of individual brain metastases were retrospectively analyzed. Subgroup analyses was performed in patients with multiple brain metastasis (n=35) and LC per lesion (n=72) was evaluated in 37 patients. Median age was 57 (27-81) years. Fifty-three percent of patients had 1-2 brain metastases, 47% had >2 and 71% presented with additional extracranial metastases. Primary treatment included systemic therapy alone (temozolomide/fotemustine, 14%), local therapy (surgery and/or stereotactic radiotherapy, 25%), whole-brain radiotherapy (WBRT, 10%), combined WBRT and systemic therapy (18%), local therapy plus WBRT (5%) and combination of local and systemic therapy (8%). Three percent received a tri-modal therapy (WBRT, local and systemic therapy) and 17% refused treatment. Median follow-up in surviving patients was 32 (4-222) months, median OS in all patients 3.9 months (1-year survival 21.4%). Local therapy (p<0.001), systemic therapy (p=0.002), number of brain metastases and primary therapy including a local therapy (p<0.001) were significantly associated with OS. In the subgroup with multiple brain metastases (n=35), a trend (p=0.058) for improved OS after initial treatment with WBRT plus systemic therapy was noted (median OS 3.8 months) and use of these two modalities over the course of the disease was significantly associated with OS (p=0.007). The best LC per single lesion (n=37) could be achieved by combination of local with systemic therapy (p=0.011). Number of brain metastases, extracranial metastases and use of local therapy are independent prognostic factors in melanoma metastatic to the brain. LC and OS can be improved by combining local with systemic treatment. In patients with multiple brain metastases, WBRT plus systemic therapy provides superior OS.

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“…Similar to prior studies, this study is retrospective (37)(38)(39) which underlines the need for confirmation of our findings in prospective randomized trials.…”

Section: Discussionsupporting

confidence: 86%

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

Ostheimer

Bormann

Fiedler

et al. 2015

International Journal of Oncology

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“…Furthermore, we observed a brain relapse rate after radiosurgery of approximately 60% at 12 months, comparable to the rate of 50% at 6 months stated by Seung et al [14] and 60% for Grob et al [34]. However, Lavine et al [35] reported only 25% of brain relapses after radiosurgery.…”

Section: Discussionsupporting

confidence: 86%

Linac Radiosurgery for Brain Metastasis of Melanoma

Noël

Simon

Valéry

et al. 2002

Stereotact Funct Neurosurg

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Purpose: To evaluate the efficacy and toxicity of stereotactic radiotherapy in the treatment of brain metastases of melanoma. Patients and Methods: From 1994 to 2001, 25 patients presenting with 61 metastases of cutaneous melanoma were treated with radiosurgery. Median age was 47 years (range: 25–73 years) and median Karnofski performance status 80 (range: 50–100). Twenty patients had one radiosurgery, 5 had two or three. Median metastasis diameter was 21 mm (range: 6–54.4 mm), and median metastasis volume was 1.7 cm³ (range: 0.4–25.6 cm³). Irradiation was delivered by a linear accelerator. Median minimal dose was 14.1 Gy (range: 10–19.4 Gy), and median maximal dose was 20.5 Gy (range: 16–48 Gy). Results: Mean follow-up was 12.6 months (range: 1–85 months). Five metastases progressed (9.8%), 2–12 months after radiosurgery. Three-, 6- and 12-month local control rates were 95 ± 3, 90 ± 5 and 84 ± 7%, respectively. By univariate analysis, only absence of extracranial tumor was a prognostic factor of local control. Three-, 6- and 12-month brain-disease-free survival rates were 75 ± 9, 68 ± 11 and 38 ± 13%, respectively. According to univariate analysis, only the Score Index for Radiosurgery in brain metastases (SIR) was a prognostic factor of brain-event-free survival (p = 0.03). Median survival was 8 months. Three-, 6- and 12-month overall survival rates were 75 ± 9, 53 ± 10, and 29 ± 10%, respectively. According to univariate analysis, extracranial controlled disease status (p = 0.03), and SIR (p = 0.04) were prognostic factors for overall survival. According to multivariate analysis, none was an independent prognosticator for overall survival. Complications were minimal. Conclusion: Radiosurgical treatment of brain metastases of melanoma is effective and accurate. The use of radiosurgery alone is an appropriate management strategy for many patients with brain metastases of melanoma.

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“…[18][19][20][21][22][23][24][25][26][27][28][29][30] In these studies SRS has generally been limited to patients with 1 to 3 metastases, with rare series accepting patients with larger numbers of lesions. 31 We report our encouraging institutional experience, based on expanded eligibility for Linac-based SRS for patients with up to 5 brain metastases, followed by planned systemic therapy.…”

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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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Radiosurgery without whole brain radiotherapy in melanoma brain metastases

Cited by 79 publications

References 17 publications

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

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

Linac Radiosurgery for Brain Metastasis of Melanoma

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

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