The relative effectiveness of radiation therapy, corticosteroids, and surgery in the management of melanoma metastatic to the central nervous system

Katz, Harry R.

doi:10.1016/0360-3016(81)90006-7

Cited by 84 publications

(41 citation statements)

References 26 publications

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“…Many studies show improved survival in those undergoing resection and also in those with no extracranial metastases (Katz 1981;Madajewicz et al, 1984;Choi et al, 1985;Ziegler and Cooper 1986;Skibber et al, 1996;Ellerhorst et al, 2001). A series of 91 patients undergoing surgical resection of MMM brain metastases showed that the outcome was better if the patient had no neurological deficit, a single supratentorial site and no lung or visceral metastases.…”

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confidence: 99%

A prognostic index that predicts outcome following palliative whole brain radiotherapy for patients with metastatic malignant melanoma

et al. 2004

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To determine the outcome of patients with metastatic malignant melanoma (MMM) treated with palliative whole brain radiotherapy (WBRT) and to identify factors that predict treatment outcome to assist future trial design, a retrospective study was performed on patients with MMM who received WBRT at the Royal Marsden Hospital between 1998 and 2003. Data regarding patient factors, tumour factors and survival were collected. A total of 112 patients were identified and full data were available for 102 patients. The median age was 53 years (range 25 -81 years), 66.7% were male and 33.3% female. The median dose prescribed was 20 Gy in five fractions as a mid-plane dose. The median survival after WBRT for the whole group was 51 days (range 3 -1386). In an attempt to define prognostic groups, we used the validated RTOG recursive partitioning analysis (RPA) classification for brain metastasis (class 1: Karnofsky Performance Score (KPS) X70%, age o65 years with no extracranial metastasis; class 3: KPS o70%; class 2: all others). The median survivals were 151, 71 and 21 days for RPA class 1, 2 and 3, respectively (Po0.001). Multivariate analysis showed that RPA class, leptomeningeal involvement, presence and number of extracranial metastatic sites and progressive disease in the brain on imaging before WBRT are important independent predictive factors. A prognostic index was derived from these factors that allowed identification of patients unlikely to benefit from WBRT. In conclusion, the RTOG RPA classification is valid when applied to patients with MMM. Patients in RPA class 1 and good prognosis class 2 are likely to benefit from palliative WBRT and should be considered for entry into trials that aim to improve duration of response. We identified that patients with RPA class 3, leptomeningeal involvement or RPA class 2 with poor prognostic index are unlikely to benefit from palliative WBRT.

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confidence: 99%

A prognostic index that predicts outcome following palliative whole brain radiotherapy for patients with metastatic malignant melanoma

et al. 2004

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“…In this study, the use of upfront WBRT did not affect overall survival in patients treated with SRS in any of the three recursive partitioning analysis (RPA) classes (15.2 vs. 14.0 months for RPA class 1, 7.0 vs. 8.2 for class 2, and 5.5 vs. 5.3 for class 3) [28]. In the recent study by Aoyama et al [9], compared with SRS alone, the use of combined WBRT and SRS did not improve survival in patients with 1 to 4 brain metastases; however, recurrence occurred more commonly in patients who received SRS alone as opposed to both SRS and WBRT. Most recently, RTOG-9508 was a randomized trial which compared WBRT with or without SRS boost in patients with 1-3 brain metastases.…”

Section: Discussionmentioning

confidence: 47%

“…However, WBRT has been associated with an acute detriment in quality-of-life measures [3], potential delayed neurocognitive deficits [4,5], and lack of overall survival benefit [6][7][8][9][10]. However, the treatment volume of the resection cavity post-operatively when SRS treatments are used may be an overestimation of the true lesion volume requiring treatment.…”

Section: Introductionmentioning

confidence: 99%

Pre-operative stereotactic radiosurgery treatment is preferred to post-operative treatment for smaller solitary brain metastases

Aliabadi¹,

Nikpour²,

Yoo³

et al. 2017

Chin Neurosurg Jl

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Background: While the optimal combination of whole-brain radiotherapy (WBRT), stereotactic radiosurgery (SRS) and surgical resection in the treatment of brain metastases, is controversial, the addition of SRS to surgical resction of solitary metastasis may enhance local control while potentially minimizing toxicity associated with adjuvant WBRT. This study seeks to determine whether pre-operative SRS to the lesion versus post-operative SRS to the resection bed may reduce irradiation of adjacent normal brain tissue. Methods: A retrospective study of 12 patients with 13 surgically resected cerebral metastases was performed. The pre-operative contrast-enhancing tumors and post-operative resection cavities plus any enhancing residual disease were contoured to yield the gross target volume (GTV). In turn these GTV's were uniformly expanded by 3-mm to generate the pre-operative, as well as post-operative planning target volume (PTV.) For each lesion, a 7-staticconformal-beam, non-coplanar plan utilizing 6 MV photons was generated to encompass the PTV within the 85% isodose line. Excess normal brain volume irradiated was defined as the volume outside the GTV receiving the prescribed dose. Results: When lesions were divided into two groups -Group A (pre-operative GTV's < 15 cc, n = 9) and Group B (pre-operative GTV's > 15 cc, n = 4) -the average volume of normal brain irradiated was significantly smaller if preoperative SRS was used for treatment of lesions in Group A (9.5 vs. 16.8 cc, paired t-test, p = 0.0045). In contrast, this volume was smaller for Group B lesions if post-operative SRS was used for treatment of these lesions (27.6 vs. 51.2 cc, p = 0.252). A comparison of groups with respect to mean volume differences between pre-and post-operative SRS was significantly different (two-sample t-test p = 0.016). GTV and the difference between pre-and postoperative volume were highly correlated (Pearson correlation = −0.875, p < 0.0001). Conclusions: Pre-operative treatment of smaller metastases may result in reduced radiation dose to normal tissue and, thus, reduced treatment-related morbidity compared to post-operative irradiation of the resection cavity.

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“…If malignant melanoma is examined, there is a prolongation of survival from 5-10 months [ 111 to 15 months [6] after additional RTalso.…”

Section: Discussionmentioning

confidence: 99%

Value of surgery and radiotherapy in the treatment of brain metastases

Nieder

Niewald

Schnabel

et al. 1994

Radation Oncology Invest

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SUMMARY In this study the results of surgery and radiotherapy (RT) in 26 patients, compared with those of 42 patients who had only RT are analyzed. The most frequent sites of primary tumors were the lung and breast. In the first years 20 x 2 Gy was given; later on 10 x 3 Gy was administered. Sixteen non-operated patients received 20 x 2 Gy followed by a local boost of 10-20 Gy. Because a matched cohort pair method was chosen for this analysis, all prognostic factors were equally distributed between the operation (OP) + whole-brain irradiation (WBI) and the WBI only group. The local remission rate after OP + WBI was 81% vs. 38.5% after WBI only and 69% after WBI + boost. Median survival after surgery (17 months) was significantly longer, but the dose of R T had no influence on survival (7 vs. 8 months). The distribution of prognostic factors was significantly different between the WBI + boost group and the other groups, and therefore a prospective randomized trial will become necessary to verify the superiority of surgical treatment compared to "high-dose" RT. When compared to "standard" R T equivalent to the 10 x 3 Gy schedule, surgery + RT is significantly superior.

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The relative effectiveness of radiation therapy, corticosteroids, and surgery in the management of melanoma metastatic to the central nervous system

Cited by 84 publications

References 26 publications

A prognostic index that predicts outcome following palliative whole brain radiotherapy for patients with metastatic malignant melanoma

A prognostic index that predicts outcome following palliative whole brain radiotherapy for patients with metastatic malignant melanoma

Pre-operative stereotactic radiosurgery treatment is preferred to post-operative treatment for smaller solitary brain metastases

Value of surgery and radiotherapy in the treatment of brain metastases

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