Response of intracranial melanoma metastases to stereotactic radiosurgery

Gieger, Michael; Wu, Fan; Ling, Marilyn N.; Wazer, David E.; Tsai, Jason Sheng‐Hong; Engler, Mark J.

doi:10.1002/(sici)1520-6823(1997)5:2<72::aid-roi5>3.0.co;2-g

Cited by 45 publications

(12 citation statements)

References 33 publications

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“…Overall median survival in the current series was 26 weeks, which is slightly lower than the 30–45 weeks reported in other series 24, 26–30. This difference is probably attributable to the higher disease burden present in the current cohort; in the current study, there were more patients with multiple intracranial lesions (71% vs. 40–62%24, 26–30) and a greater median total intracranial tumor/treatment volume (8.2 mL vs. 2.7–6.1 mL29, 30). Both of these factors have been associated with survival in other studies 26–30.…”

Section: Discussioncontrasting

confidence: 67%

“…GK radiosurgery provides a noninvasive and focal therapeutic alternative to surgical resection and WBRT, offering improved or equal efficacy with decreased morbidity. Because melanoma has traditionally been considered a radioresistant histology, a number of recent reports have reviewed the use of stereotactic radiosurgery for patients with intracranial melanoma metastases 24–30. To our knowledge, the current report is the largest to date that is limited to patients with melanoma brain metastases for whom GK radiosurgery was a part of the initial treatment plan.…”

Section: Discussionmentioning

confidence: 97%

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Initial treatment of melanoma brain metastases using gamma knife radiosurgery

Radbill

Fiveash

Falkenberg

et al. 2004

Cancer

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BACKGROUND Melanoma is the primary malignancy that is most likely to metastasize to the brain. Because such an event carries an almost uniformly poor prognosis, the current study reviewed outcomes and identified associated prognostic indicators for 51 consecutive patients receiving gamma knife (GK) radiosurgery in the initial treatment of 188 intracranial melanoma metastases. METHODS Data were collected retrospectively from a single‐center GK radiosurgery database and from primary patient medical records and radiographs. RESULTS At presentation, 71% of patients had multiple intracranial metastases, and extracranial metastases were present in 66% of patients. Thirty‐two patients (63%) were initially treated with GK radiosurgery alone, whereas the remainder received GK radiosurgery in combination with surgery and/or whole‐brain radiotherapy (WBRT). Overall median survival from time of GK radiosurgery was 26 weeks. Subgroup analysis revealed a median survival of 77 weeks for patients presenting with a single lesion, compared with 20 weeks for patients presenting with multiple lesions (P = 0.003). Patients in recursive partitioning analysis (RPA) Class I survived a median of 57 weeks, compared with a median survival of 20 weeks for patients in RPA Class II or III (P = 0.002). Although long‐term imaging follow‐up revealed that a majority of patients experienced distant brain metastases, multivariate analysis showed that distant metastases occurred significantly sooner in patients with extracranial metastases (P = 0.0004). Addition of initial WBRT had no significant effect on the time to development of new brain metastases (P = 0.13). Local control (crude) was observed in 81% of lesions initially treated with GK. Patients experienced improved or stable symptoms for a median of 37 weeks post–GK radiosurgery. CONCLUSIONS Survival analyses supported the use of GK radiosurgery in the initial treatment of patients with melanoma brain metastases, with best results occurring in patients presenting with a single lesion. Cancer 2004. © 2004 American Cancer Society.

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Section: Discussioncontrasting

confidence: 67%

Section: Discussionmentioning

confidence: 97%

Initial treatment of melanoma brain metastases using gamma knife radiosurgery

Radbill

Fiveash

Falkenberg

et al. 2004

Cancer

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“…27,28 Resection of melanoma metastases in this immunotherapy series resulted in a local control rate of 92.5%, which compares favorably to the local control rates reported in other series after brain metastasis resection (54%–88% local control rate) 4,16 and SRS (49%–86% local control rate). 8,15,18,24 …”

Section: Discussionmentioning

confidence: 99%

Surgical management of melanoma brain metastases in patients treated with immunotherapy

Lonser¹,

Song²,

Klapper³

et al. 2011

JNS

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Object Despite the increasing use of immunotherapy in the treatment of metastatic melanoma, the effects of this therapy on the management of patients with associated brain metastases are not completely defined. The authors undertook this study to determine the effectiveness of resection and the effects of immunotherapy on brain metastasis management. Methods The authors analyzed data pertaining to consecutive patients with metastatic melanoma treated with immunotherapy within 3 months of discovery of brain metastases that were surgically resected. Results Forty-one patients (median age 44.4 years, range 19.2–63.1 years) underwent resection of 53 brain metastases (median number of metastases 1, range 1–4). The median metastasis volume was 2.5 cm3. Fifteen patients underwent whole-brain radiation therapy (WBRT) and 26 patients did not. Duration of survival from brain metastasis diagnosis was not significantly different between patients who received WBRT (mean 24.9 months) and those who did not (mean 23.3 months) (p > 0.05). Local and distant brain recurrence rates were not statistically different between the WBRT (7.1% and 28.6%, respectively) and non-WBRT (7.7% and 41.0%) groups for the duration of follow-up (p > 0.05). An objective systemic response to immunotherapy was associated with increased duration of survival (p < 0.05). Conclusions Resection of melanoma brain metastases in patients treated with immunotherapy provides excellent local control with low morbidity. An objective response to systemic immunotherapy is associated with a prolonged survival in patients who have undergone resection of melanoma brain metastases. Moreover, adjuvant WBRT in melanoma immunotherapy patients with limited metastatic disease to the brain does not appear to provide a significant survival benefit.

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“…21 Mori and colleagues 39 from the University of Pittsburgh reviewed 60 patients with melanoma whose 118 metastatic lesions were treated by gamma knife radiosurgery over a 9-year period. The authors used mean rather than median figures in reporting their results, which sometimes make it impossible to compare with other similar series.…”

Section: Stereotactic Radiosurgerymentioning

confidence: 99%