To evaluate the role of stereotactic radiosurgery (SRS) in the management of brain metastases from melanoma, the authors assessed clinical outcomes and prognostic factors for survival and tumor control.
The authors reviewed 333 consecutive patients with melanoma who underwent SRS for 1570 brain metastases from cutaneous and mucosal/acral melanoma. The patient population consisted of 109 female and 224 male patients with a median age of 53 years. Two hundred eleven patients (63%) had multiple metastases. One hundred eighteen patients (35%) underwent whole-brain radiation therapy (WBRT). The target volume ranged from 0.1 cm3to 37.2 cm3. The median marginal dose was 18 Gy.
Actuarial survival rates were 70% at 3 months, 47% at 6 months, 25% at 12 months, and 10% at 24 months after radiosurgery. Factors associated with longer survival included controlled extracranial disease, better Karnofsky Performance Scale score, fewer brain metastases, no prior WBRT, no prior chemotherapy, administration of immunotherapy, and no intratumoral hemorrhage before radiosurgery. The median survival for patients with a solitary brain metastasis, controlled extracranial disease, and administration of immunotherapy after radiosurgery was 22 months. Sustained local tumor control was achieved in 73% of the patients. Sixty-four (25%) of 259 patients who had follow-up imaging after SRS had evidence of delayed intratumoral hemorrhage. Sixteen patients underwent a craniotomy due to intratumoral hemorrhage. Seventeen patients (6%) had asymptomatic and 21 patients (7%) had symptomatic radiation effects. Patients with ≤ 8 brain metastases, no prior WBRT, and the recursive partitioning analysis Class I had extended survivals (median 54.3 months).
Stereotactic radiosurgery is an especially valuable option for patients with controlled systemic disease even if they have multiple metastatic brain tumors.
* Drs. Liew and Kano contributed equally to this work.
Please include this information when citing this paper: published online June 4, 2010; DOI: 10.3171/2010.5.JNS1014.
AtkinsMB,,SosmanJA,,AgarwalaS,,LoganT,,ClarkJI,&ErnstoffMS,et al.:Temozolomide, thalidomide, and whole brain radiation therapy for patients with brain metastasis from metastatic melanoma: a phase II Cytokine Working Group study.Cancer113:2139–2145,2008
BafaloukosD,&GogasH:The treatment of brain metastases in melanoma patients.Cancer Treat Rev30:515–520,2004
BamiasA,,AravantinosG,,DeliveliotisC,,BafaloukosD,,KalofonosC,&XirosN,et al.:Docetaxel and cisplatin with granulocyte colony-stimulating factor (G-CSF) versus MVAC with G-CSF in advanced urothelial carcinoma: a multicenter, randomized, phase III study from the Hellenic Cooperative Oncology Group.J Clin Oncol22:220–228,2004
BhatnagarAK,,FlickingerJC,,KondziolkaD,&LunsfordLD:Stereotactic radiosurgery for four or more intracranial metastases.Int J Radiat Oncol Biol Phys64:898–903,2006
BrownPD,,BrownCA,,PollockBE,,GormanDA,&FooteRL:Stereotactic radiosurgery for patients with “radioresistant” brain metastases.开云体育app官方网站下载入口62:Suppl 2790–801,2008
BuchsbaumJC,,SuhJH,,LeeSY,,ChidelMA,,GreskovichJF,&BarnettGH:Survival by radiation therapy oncology group recursive partitioning analysis class and treatment modality in patients with brain metastases from malignant melanoma: a retrospective study.Cancer94:2265–2272,2002
ChangEL,,SelekU,,HassenbuschSJIII,,MaorMH,,AllenPK,&MahajanA,et al.:Outcome variation among “radioresistant” brain metastases treated with stereotactic radiosurgery.开云体育app官方网站下载入口56:936–945,2005
ChristopoulouA,,RetsasS,,KingsleyD,,PaddickI,&LindquistC:Integration of gamma knife surgery in the management of cerebral metastases from melanoma.Melanoma Res16:51–57,2006
DiLunaML,,KingJTJr,,KniselyJP,&ChiangVL:Prognostic factors for survival after stereotactic radiosurgery vary with the number of cerebral metastases.Cancer109:135–145,2007
DossLL,&MemulaN:The radioresponsiveness of melanoma.Int J Radiat Oncol Biol Phys8:1131–1134,1982
EisenhauerEA,,TherasseP,,BogaertsJ,,Schwartz韩,,SargentD,&FordR,et al.:New response evaluation criteria in solid tumours: revised RECIST guideline (version 1.1).Eur J Cancer45:228–247,2009
EllerhorstJ,,StromE,,NardoneE,&McCutcheonI:Whole brain irradiation for patients with metastatic melanoma: a review of 87 cases.Int J Radiat Oncol Biol Phys49:93–97,2001
FifeKM,,ColmanMH,,StevensGN,,FirthIC,,MoonD,&ShannonKF,et al.:Determinants of outcome in melanoma patients with cerebral metastases.J Clin Oncol22:1293–1300,2004
Gaudy-MarquesteC,,RegisJM,,MuraccioleX,,LauransR,,RichardMA,&BonerandiJJ,et al.:Gamma-Knife radiosurgery in the management of melanoma patients with brain metastases: a series of 106 patients without whole-brain radiotherapy.Int J Radiat Oncol Biol Phys65:809–816,2006
GearaFB,&AngKK:Radiation therapy for malignant melanoma.Surg Clin North Am76:1383–1398,1996
GiegerM,,WuJK,,LingMN,,WazerD,,TsaiJS,&EnglerMJ:Response of intracranial melanoma metastases to stereotactic radiosurgery.Radiat Oncol Investig5:72–80,1997
GroomsGA,,EilberFR,&MortonDL:Failure of adjuvant immunotherapy to prevent central nervous system metastases in malignant melanoma patients.J Surg Oncol9:147–153,1977
GuirguisLM,,YangJC,,WhiteDE,,SteinbergSM,,LiewehrDJ,&RosenbergSA,et al.:Safety and efficacy of high-dose interleukin-2 therapy in patients with brain metastases.J Immunother25:82–87,2002
HaraW,,TranP,,LiG,,SuZ,,PuataweepongP,&AdlerJRJr,et al.:Cyberknife for brain metastases of malignant melanoma and renal cell carcinoma.开云体育app官方网站下载入口64:2 SupplA26–A32,2009
HerfarthKK,,IzwekowaO,,ThilmannC,,PirzkallA,,DelormeS,&HofmannU,et al.:Linac-based radiosurgery of cerebral melanoma metastases. Analysis of 122 metastases treated in 64 patients.Strahlenther Onkol179:366–371,2003
JensenRL,,ShrieveAF,,SamlowskiW,&ShrieveDC:Outcomes of patients with brain metastases from melanoma and renal cell carcinoma after primary stereotactic radiosurgery.Clin Neurosurg55:150–159,2008
KocM,,McGregorJ,,GreculaJ,,BauerCJ,,GuptaN,&GahbauerRA:Gamma Knife radiosurgery for intracranial metastatic melanoma: an analysis of survival and prognostic factors.J Neurooncol71:307–313,2005
KondziolkaD,,BernsteinM,,ReschL,,TatorCH,,FlemingJF,&VanderlindenRG,et al.:Significance of hemorrhage into brain tumors: clinicopathological study.J Neurosurg67:852–857,1987
KornEL,,LiuPY,,LeeSJ,,ChapmanJA,,NiedzwieckiD,&SumanVJ,et al.:Meta-analysis of phase II cooperative group trials in metastatic stage IV melanoma to determine progression-free and overall survival benchmarks for future phase II trials.J Clin Oncol26:527–534,2008
KouvarisJR,,MiliadouA,,KoulouliasVE,,KolokourisD,,BalafoutaMJ,&PapacharalampousXN,et al.:Phase II study of temozolomide and concomitant whole-brain radiotherapy in patients with brain metastases from solid tumors.Onkologie30:361–366,2007
LagerwaardFJ,,LevendagPC,,NowakPJ,,EijkenboomWM,,HanssensPE,&SchmitzPI:识别患者的预后因素ith brain metastases: a review of 1292 patients.Int J Radiat Oncol Biol Phys43:795–803,1999
LavineSD,,PetrovichZ,,Cohen-GadolAA,,MasriLS,,MortonDL,&O'DaySJ,et al.:Gamma knife radiosurgery for metastatic melanoma: an analysis of survival, outcome, and complications.开云体育app官方网站下载入口44:59–66,1999
LorenzoniJ,,DevriendtD,,MassagerN,,DavidP,,RuízS,&VanderlindenB,et al.:Radiosurgery for treatment of brain metastases: estimation of patient eligibility using three stratification systems.Int J Radiat Oncol Biol Phys60:218–224,2004
ManonR,,O'NeillA,,KniselyJ,,Werner-WasikM,,LazarusHM,&WagnerH,et al.:Phase II trial of radiosurgery for one to three newly diagnosed brain metastases from renal cell carcinoma, melanoma, and sarcoma: an Eastern Cooperative Oncology Group study (E 6397).J Clin Oncol23:8870–8876,2005
MathieuD,,KondziolkaD,,CooperPB,,FlickingerJC,,NiranjanA,&AgarwalaS,et al.:Gamma knife radiosurgery in the management of malignant melanoma brain metastases.开云体育app官方网站下载入口60:471–482,2007
MeierS,,BaumertBG,,MaierT,,WellisG,,BurgG,&SeifertB,et al.:Survival and prognostic factors in patients with brain metastases from malignant melanoma.Onkologie27:145–149,2004
MingioneV,,OliveiraM,,PrasadD,,SteinerM,&SteinerL:Gamma surgery for melanoma metastases in the brain.J Neurosurg96:544–551,2002
MoriY,,KondziolkaD,,FlickingerJC,,KirkwoodJM,,AgarwalaS,&LunsfordLD:Stereotactic radiosurgery for cerebral metastatic melanoma: factors affecting local disease control and survival.Int J Radiat Oncol Biol Phys42:581–589,1998
NoëlG,,SimonJM,,ValeryCA,,CornuP,,BoisserieG,&LeduD,et al.:Linac radiosurgery for brain metastasis of melanoma.Stereotact Funct Neurosurg79:245–255,2002
OttPA,,ChangJL,,OratzR,,JonesA,,FarrellK,&MuggiaF,et al.:Phase II trial of dacarbazine and thalidomide for the treatment of metastatic melanoma.Chemotherapy55:221–227,2009
PowellJW,,ChungCT,,ShahHR,,CanuteGW,,HodgeCJ,&BassanoDA,et al.:Gamma Knife surgery in the management of radioresistant brain metastases in high-risk patients with melanoma, renal cell carcinoma, and sarcoma.J Neurosurg109:Suppl122–128,2008
RadbillAE,,FiveashJF,,FalkenbergET,,GuthrieBL,,YoungPE,&MelethS,et al.:Initial treatment of melanoma brain metastases using gamma knife radiosurgery: an evaluation of efficacy and toxicity.Cancer101:825–833,2004
RedmondAJ,,DilunaML,,HebertR,,MoliternoJA,,DesaiR,&KniselyJP,et al.:Gamma Knife surgery for the treatment of melanoma metastases: the effect of intratumoral hemorrhage on survival.J Neurosurg109:Suppl99–105,2008
SahaS,,MeyerM,,KrementzET,,HodaS,,CarterRD,&MuchmoreJ,et al.:Prognostic evaluation of intracranial metastasis in malignant melanoma.Ann Surg Oncol1:38–44,1994
SamlowskiWE,,WatsonGA,,WangM,,饶G,,KlimoPJr,&BoucherK,et al.:Multimodality treatment of melanoma brain metastases incorporating stereotactic radiosurgery (SRS).Cancer109:1855–1862,2007
SampsonJH,,CarterJHJr,,FriedmanAH,&SeiglerHF:Demographics, prognosis, and therapy in 702 patients with brain metastases from malignant melanoma.J Neurosurg88:11–20,1998
SavasB,,ArslanG,,GelenT,,KarpuzogluG,&OzkaynakC:Multidrug resistant malignant melanoma with intracranial metastasis responding to immunotherapy.Anticancer Res19:5C4413–4420,1999
SelekU,,ChangEL,,HassenbuschSJIII,,ShiuAS,,LangFF,&AllenP,et al.:Stereotactic radiosurgical treatment in 103 patients for 153 cerebral melanoma metastases.Int J Radiat Oncol Biol Phys59:1097–1106,2004
SeungSK,,SneedPK,,McDermottMW,,ShuHK,,LeongSP,&ChangS,et al.:Gamma knife radiosurgery for malignant melanoma brain metastases.Cancer J Sci Am4:103–109,1998
SinAH,,CardenasRJ,,VannemreddyP,&NandaA:伽玛刀立体定向radiosurgery for intracranial metastases from conventionally radioresistant primary cancers: outcome analysis of survival and control of brain disease.South Med J102:42–44,2009
SloanAE,,NockCJ,&爱因斯坦DB:Diagnosis and treatment of melanoma brain metastasis: a literature review.Cancer Control16:248–255,2009
SomazaS,,KondziolkaD,,LunsfordLD,,KirkwoodJM,&FlickingerJC:Stereotactic radiosurgery for cerebral metastatic melanoma.J Neurosurg79:661–666,1993
TarhiniAA,&AgarwalaSS:Management of brain metastases in patients with melanoma.Curr Opin Oncol16:161–166,2004
TarhiniAA,,KirkwoodJM,,GoodingWE,,MoschosS,&AgarwalaSS:A phase 2 trial of sequential temozolomide chemotherapy followed by high-dose interleukin 2 immunotherapy for metastatic melanoma.Cancer113:1632–1640,2008
TsaoH,,AtkinsMB,&SoberAJ:Management of cutaneous melanoma.N Engl J Med351:998–1012,2004
WeltmanE,,SalvajoliJV,,BrandtRA,,de Morais HanriotR,,PriscoFE,&CruzJC,et al.:Radiosurgery for brain metastases: a score index for predicting prognosis.Int J Radiat Oncol Biol Phys46:1155–1161,2000
WrońskiM,&ArbitE:Surgical treatment of brain metastases from melanoma: a retrospective study of 91 patients.J Neurosurg93:9–18,2000
YuC,,ChenJC,,ApuzzoML,,O'DayS,,GiannottaSL,&WeberJS,et al.:Metastatic melanoma to the brain: prognostic factors after gamma knife radiosurgery.Int J Radiat Oncol Biol Phys52:1277–1287,2002
ZacestAC,,BesserM,,StevensG,,ThompsonJF,,McCarthyWH,&CuljakG:Surgical management of cerebral metastases from melanoma: outcome in 147 patients treated at a single institution over two decades.J Neurosurg96:552–558,2002
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