title: Biochemotherapy for metastatic melanoma with limited central nervous system involvement.
abstract: OBJECTIVE
  Biochemotherapy outcomes were examined in stage IV melanoma patients with previously treated or active central nervous system (CNS) metastases prior to systemic therapy.
  
  
  METHODS
  Patients who received biochemotherapy for metastatic melanoma with active or pretreated CNS metastases were compared to patients without evidence of CNS metastases in terms of response, time to progression (TTP), overall survival (OS), and treatment toxicity.
  
  
  RESULTS
  Twenty-six (16%) of 159 total patients began biochemotherapy with previously treated or active CNS metastases (group I), compared to 133 (84%) who were radiographically free of CNS involvement (group II). A partial or complete response to biochemotherapy was seen in 13 (50%) group I patients, compared to 56 (42%) group II patients (p = 0.243). The median TTP and median survival were 5.5 and 7.0 months, respectively, for group I patients and 6.0 and 9.9 months, respectively, for group II patients (p = 0.222 and 0.434 for TTP and OS, respectively). Five (19%) group I patients survived longer than 24 months. Gamma Knife radiosurgery or surgical resection of CNS disease prior to biochemotherapy improved survival versus delayed treatment (p = 0.017 and 0.005, respectively).
  
  
  CONCLUSIONS
  Patients with limited CNS metastases and widespread systemic disease can achieve prolonged survival with targeted treatment of CNS lesions and aggressive systemic therapy.
authors.affiliation: Division of Medical Oncology, John Wayne Cancer Institute, Saint John's Health Center, Santa Monica, CA 90404, USA. boasbergp@jwci.org
authors.forename: Peter D
authors.initials: PD
authors.lastname: Boasberg
authors.forename: Steven J
authors.initials: SJ
authors.lastname: O'Day
authors.forename: Tim S
authors.initials: TS
authors.lastname: Kristedja
authors.forename: Maureen
authors.initials: M
authors.lastname: Martin
authors.forename: Hejing
authors.initials: H
authors.lastname: Wang
authors.forename: Regina
authors.initials: R
authors.lastname: Deck
authors.forename: Kelly
authors.initials: K
authors.lastname: Shinn
authors.forename: Pat
authors.initials: P
authors.lastname: Ames
authors.forename: Beth
authors.initials: B
authors.lastname: Tamar
authors.forename: Zbigniew
authors.initials: Z
authors.lastname: Petrovich
mesh_terms: D000328:Adult; D000368:Aged; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000009:adverse effects / Q000627:therapeutic use*; D016543:Central Nervous System Neoplasms / Q000188:drug therapy* / Q000556:secondary* / Q000601:surgery; D002945:Cisplatin / Q000008:administration & dosage; D003606:Dacarbazine / Q000008:administration & dosage; D018450:Disease Progression; D005260:Female; D006801:Humans; D000077190:Interferon alpha-2; D016898:Interferon-alpha / Q000008:administration & dosage; D007376:Interleukin-2 / Q000008:administration & dosage; D008297:Male; D008545:Melanoma / Q000188:drug therapy* / Q000556:secondary* / Q000601:surgery; D008875:Middle Aged; D009367:Neoplasm Staging; D016634:Radiosurgery; D011994:Recombinant Proteins; D016019:Survival Analysis; D016896:Treatment Outcome; D014747:Vinblastine / Q000008:administration & dosage
chemical_list: D000077190:Interferon alpha-2; D016898:Interferon-alpha; D007376:Interleukin-2; D011994:Recombinant Proteins; D014747:Vinblastine; D003606:Dacarbazine; D002945:Cisplatin