title: Gamma Knife radiosurgery for intracranial metastatic melanoma: an analysis of survival and prognostic factors.
abstract: Objective of this study was to evaluate retrospectively the effectiveness of Gamma Knife radiosurgery for intracranial metastatic melanoma and to identify prognostic factors related to survival. Twenty-six patients with intracranial metastases (72 lesions) from melanoma underwent Gamma Knife radiosurgery. In 14 patients (54%) whole-brain radiotherapy (WBRT) was performed as part of the initial treatment, and in 12 patients (38%) immunotherapy and/or chemotherapy was given after Gamma Knife radiosurgery. The median tumor volume for Gamma Knife radiosurgery treated lesions was 1.72 cm3. The median prescribed radiation dose was 18 Gy (range 8-22 Gy) typically prescribed to the isodose at the tumor margin. Univariate and multivariate analyses were used to determine significant prognostic factors affecting survival. Overall median survival was 6 months after Gamma Knife radiosurgery, and 1-year survival was 25%. The median survival from the onset of brain metastases was 9 months and from the original diagnosis of melanoma was 50 months (range 4-160 months). There were no major acute or late GKS complications. In univariate testing, the Karnofsky score equal to or higher than 90% (P < 0.01, log-rank test), supratentorial localization (P < 0.001, log-rank test), intracranial tumor volume less than 1 cm3 (P < 0.02, log-rank test), and absence of neurological signs or symptoms before Gamma Knife radiosurgery (P < 0.003, log-rank test) were significant favorable factors for survival. In multivariate regression analyses, the most important predictors associated with increased survival were a KPS > or = 90 (P < 0.023), female sex (P < 0.004), supratentorial localization (P < 0.01), and absence of neurological symptoms (P < 0.008). Radiosurgery is a noninvasive, safe, and effective treatment option for patients with single or multiple intracranial metastases from melanoma. Female sex, Karnofsky score > or = 90, supratentorial localization and lack of symptoms before the Gamma Knife radiosurgery were good independent predictors of survival.
authors.affiliation: Division of Radiation Oncology, Arthur G. James Cancer Hospital and Research Institute, The Ohio State University, Columbus, OH, USA. mkoc@atauni.edu.tr
authors.forename: Mehmet
authors.initials: M
authors.lastname: Koc
authors.forename: John
authors.initials: J
authors.lastname: McGregor
authors.forename: John
authors.initials: J
authors.lastname: Grecula
authors.forename: Constance J
authors.initials: CJ
authors.lastname: Bauer
authors.forename: Nilendu
authors.initials: N
authors.lastname: Gupta
authors.forename: Reinhard A
authors.initials: RA
authors.lastname: Gahbauer
mesh_terms: D000328:Adult; D000368:Aged; D001932:Brain Neoplasms / Q000401:mortality / Q000556:secondary* / Q000601:surgery* / Q000628:therapy; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008545:Melanoma / Q000401:mortality / Q000556:secondary* / Q000601:surgery* / Q000628:therapy; D008875:Middle Aged; D011379:Prognosis; D016634:Radiosurgery / Q000295:instrumentation*; D012189:Retrospective Studies; D012737:Sex Factors; D012878:Skin Neoplasms / Q000401:mortality / Q000473:pathology; D016019:Survival Analysis; D016896:Treatment Outcome
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