Stereotactic radiosurgery for cerebral metastatic melanoma: factors affecting local disease control and survival

Mori, Yoshimasa; Kondziolka, Douglas; Flickinger, John C.; Kirkwood, John M.; Agarwala, Sanjiv S.; Lunsford, L. Dade

doi:10.1016/s0360-3016(98)00272-7

Cited by 243 publications

(153 citation statements)

References 36 publications

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“…This median survival was less impressive than that achieved by the group who underwent SRS for BM from other primary cancers (lung, 10 months; renal cell, 11 months; breast, 13 months; melanoma, 7 months). [32][33][34][35] The local control rate was 84% and there were few side effects. However, the patients in that study who had active extracranial disease had a median survival of only 2 months after SRS.…”

Section: Discussionmentioning

confidence: 88%

Multidisciplinary management of colorectal brain metastases

Kruser

Chao

Elson

et al. 2008

Cancer

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BACKGROUND.The incidence of brain metastases (BM) from colorectal cancer (CRC) is increasing, and the management of this previously rare complication at a single institution is reported.METHODS.The records of all patients with BM from 1994 to 2005 were reviewed, and 49 patients (33 men, 16 women) with 102 BM from CRC were identified. Associations between patient and tumor characteristics, treatment modality, and survival were assessed.RESULTS.The median age at diagnosis of BM from CRC was 66 years. Forty patients (82%) had other systemic disease. The median survival after a diagnosis of BM from CRC was 5.1 months. Fifteen patients (31%) underwent surgery at some point, 14 patients (29%) underwent stereotactic radiosurgery (SRS), and 42 patients (86%) received whole‐brain radiotherapy during their management. Seven patients (14%) underwent upfront SRS. On multivariate analysis, a longer interval from diagnosis of CRC to diagnosis of BM was associated significantly with shorter survival (p = .01). Sex, Karnofsky performance status, tumor location, recursive partitioning analysis class, and initial treatment modality did not have an impact on survival.CONCLUSIONS.Because BM from CRC are a late‐stage phenomenon, the majority of patients in the current study had other systemic involvement, and survival after CNS involvement was poor. The results indicated that a high prevalence of systemic disease limits the proportion of patients who are strong candidates for upfront SRS, thereby limiting the impact that this modality has on outcomes in this population as a whole. Late development (>1 year after the primary tumor diagnosis) of CNS involvement may predict for poorer survival after therapy for patients with BM from CRC. Cancer 2008. © 2008 American Cancer Society.

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Section: Discussionmentioning

confidence: 88%

Multidisciplinary management of colorectal brain metastases

Kruser

Chao

Elson

et al. 2008

Cancer

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“…Many studies report no benefit to overall survival [7][8][9], although some neurological symptoms palliation may be offered for symptomatic patients. Others suggest that certain circumstances, such as stable extra-cranial disease or adjuvant treatment with SRS or neurosurgery, may enable WBRT to control intracranial disease for a limited period of time [11].…”

Section: Discussionmentioning

confidence: 99%

“…The evidence base for the efficacy of WBRT in the treatment of melanoma brain metastases is inconclusive. Many studies have shown no improvement in OS [7][8][9]. It has been hypothesised that this may be due to the resistant nature of melanoma cells to non-SRS radiation, having some ability to repair themselves following radiation insult [9,10].…”

Section: Introductionmentioning

confidence: 99%

Metastatic melanoma: prognostic factors and survival in patients with brain metastases

Frinton¹,

Tong²,

Tan³

et al. 2017

European Journal of Cancer

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“…Predictors for OS in patients with malignant melanoma metastatic to the brain have been published previously and include Ldh levels, age, karnofsky index, number of brain metastasis, leptomeningeal spread, presence of extracerebral metastases, melanoma ulceration, histology and neurologic symptoms (10,13,18,25,37,(39)(40)(41)(42).…”

Section: Discussionmentioning

confidence: 99%

“…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).…”

Section: Introductionmentioning

confidence: 99%

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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Stereotactic radiosurgery for cerebral metastatic melanoma: factors affecting local disease control and survival

Cited by 243 publications

References 36 publications

Multidisciplinary management of colorectal brain metastases

Multidisciplinary management of colorectal brain metastases

Metastatic melanoma: prognostic factors and survival in patients with brain metastases

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

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