[The value of radiotherapy in treatment of meningeal melanocytoma].
BACKGROUND
Meningeal melanocytoma is described as rare benign lesion with a high risk of recurrence. There are no well-substantiated treatment recommendations in the literature. Only case reports have been published by now.


METHODS
In 1997 a patient was irradiated for a recurrent spinal meningeal melanocytoma and 2 years later for brain metastases indicating malignant transformation. This case gave rise to a literature review for therapeutic options. All sufficiently documented cases published since 1972, when the term meningeal melanocytoma was established, were evaluated. Based on published and on original data recurrence and overall survival rates up to 5 years were calculated for three different therapeutic approaches, namely complete tumor resection, incomplete resection with subsequent radiotherapy, and incomplete resection alone. Statistical evaluation was performed using the chi 2 test and Kaplan-Meier-analysis.


RESULTS
53 patients (including our patient) met selection criteria. Complete tumor resection was superior to incomplete resection alone with lower recurrence (4-38% versus 50-92%) and better overall survival rates (86-95% versus 30-58%). After incomplete resection radiotherapy seemed to improve prognosis (recurrence 15-45%; overall survival 91-92%). Between complete resection and incomplete resection plus radiotherapy no significant differences were observed.


CONCLUSIONS
For meningeal melanocytoma complete resection must be regarded as the best of the modalities compared. After incomplete resection radiotherapy should be considered, although a specific radiotherapeutic regimen cannot be recommended at present. However, for multiple cranial or spinal lesions total cranial irradiation or craniospinal irradiation is indicated.
Rades
Dirk
D
Abteilung für Strahlentherapie und spezielle Onkologie, Medizinische Hochschule Hannover. Rades.Dirk@gmx.net
Tatagiba
Marcos
M
Brandis
Almuth
A
Dubben
Hans-Hermann
HH
Karstens
Johann Hinrich
JH
D000293:Adolescent; D000328:Adult; D000368:Aged; D016371:Cranial Irradiation; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D008545:Melanoma / Q000175:diagnosis / Q000401:mortality / Q000532:radiotherapy* / Q000601:surgery; D008577:Meningeal Neoplasms / Q000175:diagnosis / Q000401:mortality / Q000532:radiotherapy* / Q000601:surgery; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000175:diagnosis / Q000401:mortality / Q000532:radiotherapy / Q000601:surgery; D018365:Neoplasm, Residual / Q000175:diagnosis / Q000401:mortality / Q000532:radiotherapy / Q000601:surgery; D009506:Nevus / Q000175:diagnosis / Q000401:mortality / Q000532:radiotherapy* / Q000601:surgery; D011379:Prognosis; D018714:Radiotherapy, Adjuvant; D015996:Survival Rate