title: Linac-based radiosurgery of cerebral melanoma metastases. Analysis of 122 metastases treated in 64 patients.
abstract: OBJECTIVE
  Stereotactic radiosurgery is an alternative option to neurosurgical excision in the management of patients with brain metastases. We retrospectively analyzed patients with brain metastases of malignant melanoma who were treated at our institution for outcome and prognostic factors.
  
  
  METHODS
  64 patients with 122 cerebral metastases were treated with stereotactic radiosurgery between 1986 and 2000. Twelve patients (19%) showed neurologic symptoms at the time of treatment, and 46 patients (72%) had extracerebral tumor manifestation at that time. The median dose to the 80% isodose line, prescribed to encompass the tumor margin, was 20 Gy (range, 15-22 Gy).
  
  
  RESULTS
  Neurologic symptoms improved in five of twelve symptomatic patients. 41 patients remained asymptomatic or unchanged in their neurologic symptoms. Only five patients (8%) temporarily worsened neurologically after therapy despite no signs of tumor progression. With a mean follow-up time of 9.4 months, actuarial local control was 81% after 1 year. There was a statistically significant dose and size dependency of local tumor control. Median actuarial survival after treatment was 10.6 months. Patients without extracerebral tumor manifestation showed a superior survival (p = 0.04).
  
  
  CONCLUSIONS
  Despite high local tumor control rates, the prognosis of patients with cerebral metastases of malignant melanoma remains poor. Stereotactic radiosurgery has the potential of stabilizing or improving neurologic symptoms in these patients in a palliative setting.
authors.affiliation: Division of Radiation Oncology, German Cancer Research Center, and Department of Radiation Oncology, University of Heidelberg, Germany. k.herfarth@dkfz.de
authors.forename: Klaus K
authors.initials: KK
authors.lastname: Herfarth
authors.forename: Oxana
authors.initials: O
authors.lastname: Izwekowa
authors.forename: Christoph
authors.initials: C
authors.lastname: Thilmann
authors.forename: Andrea
authors.initials: A
authors.lastname: Pirzkall
authors.forename: Stefan
authors.initials: S
authors.lastname: Delorme
authors.forename: Udo
authors.initials: U
authors.lastname: Hofmann
authors.forename: Dirk
authors.initials: D
authors.lastname: Schadendorf
authors.forename: Dietmar
authors.initials: D
authors.lastname: Zierhut
authors.forename: Michael
authors.initials: M
authors.lastname: Wannenmacher
authors.forename: Jürgen
authors.initials: J
authors.lastname: Debus
mesh_terms: D001932:Brain Neoplasms / Q000401:mortality / Q000556:secondary* / Q000601:surgery*; D003131:Combined Modality Therapy; D005260:Female; D006801:Humans; D008297:Male; D008545:Melanoma / Q000401:mortality / Q000473:pathology / Q000532:radiotherapy / Q000601:surgery*; D008875:Middle Aged; D009362:Neoplasm Metastasis / Q000532:radiotherapy*; D010315:Particle Accelerators; D016634:Radiosurgery / Q000379:methods*; D012189:Retrospective Studies; D015996:Survival Rate; D013997:Time Factors; D016896:Treatment Outcome