title: Gamma surgery for melanoma metastases in the brain.
abstract: OBJECTIVE
  The aim of this study was to evaluate the usefulness and limitations of gamma surgery (GS) in the treatment of brain metastases from melanoma.
  
  
  METHODS
  Imaging and clinical outcomes in 45 patients treated for 92 brain metastases from melanoma between October 1989 and October 1999 were retrospectively analyzed. Follow-up imaging studies were available in 35 patients with 66 treated lesions. Twenty-four percent of the lesions disappeared, 35% shrank, 23% remained unchanged, and 18% increased in size. No undue radiation-induced changes were observed in the surrounding brain. Clinical data were available in all patients. No deaths or neurological morbidity related to GS was observed. The median survival time, calculated using the Kaplan-Meier method, was 10.4 months from the time of GS. In both univariate and multivariate Cox regression analyses, a single brain lesion and lack of visceral metastases were statistically predictive of a better prognosis. Six of eight patients with solitary metastasis (that is, a single brain metastasis with no primary visceral tumor) were still alive at the close of the study, none of them with disease progression, with a follow-up period ranging between 14 and 82 months. Sixteen patients in this series received adjunctive whole-brain radiation therapy, which had no impact on their survival time or local and distant control of the brain disease.
  
  
  CONCLUSIONS
  Gamma surgery is effective in treating melanoma metastases in the brain. It appears that the radiobiology of a single high dose overcomes the radioresistance barrier, yielding better results than fractionated radiation.
authors.affiliation: Lars Leksell Center for Gamma Surgery, Department of Neurological Surgery, University of Virginia, Charlottesville 22908, USA.
authors.forename: Vincenzo
authors.initials: V
authors.lastname: Mingione
authors.forename: Marcelo
authors.initials: M
authors.lastname: Oliveira
authors.forename: Dheerendra
authors.initials: D
authors.lastname: Prasad
authors.forename: Melita
authors.initials: M
authors.lastname: Steiner
authors.forename: Ladislau
authors.initials: L
authors.lastname: Steiner
mesh_terms: D001921:Brain / Q000473:pathology / Q000601:surgery; D001932:Brain Neoplasms / Q000175:diagnosis / Q000401:mortality / Q000556:secondary* / Q000601:surgery; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D008545:Melanoma / Q000175:diagnosis / Q000401:mortality / Q000556:secondary* / Q000601:surgery; D008875:Middle Aged; D011379:Prognosis; D016634:Radiosurgery; D012878:Skin Neoplasms / Q000175:diagnosis / Q000401:mortality / Q000601:surgery*; D015996:Survival Rate