title: Gamma-Knife radiosurgery in the management of melanoma patients with brain metastases: a series of 106 patients without whole-brain radiotherapy.
abstract: OBJECTIVE
  To assess retrospectively a strategy that uses Gamma-Knife radiosurgery (GKR) in the management of patients with brain metastases (BMs) of malignant melanoma (MM).
  
  
  METHODS
  GKR without whole-brain radiotherapy (WBRT) was performed for patients with Karnofsky Performance Status (KPS) of 60 or above who harbored 1 to 4 BMs of 30 mm or less and was repeated as often as needed. Survival was assessed in the whole population, whereas local-control rates were assessed for patients with follow-up longer than 3 months.
  
  
  RESULTS
  A total of 221 BMs were treated in 106 patients; 61.3% had a single BM. Median survival from the time of GKR was 5.09 months. Control rate of treated BMs was 83.7%, with 14% of complete response (14 BMs), 42% of partial response (41 BMs), and 43% of stabilization (43 BMs). In multivariate analysis, survival prognosis factors retained were KPS greater than 80, cortical or subcortical location, and Score Index for Radiosurgery (SIR) greater than 6. On the basis of KPS, BM location, and age, a score called MM-GKR, predictive of survival in our population, was defined.
  
  
  CONCLUSIONS
  Gamma-Knife radiosurgery provides a surgery-like ability to obtain control of a solitary BM and could be consider as an alternative treatment to the combination of GKR+WBRT as a palliative strategy. MM-GKR classification is more adapted to MM patients than are SIR, RPA and Brain Score for Brain Metastasis.
authors: Dermatology Department, Hôpital Sainte Marguerite, Marseille, France. marqueste@wanadoo.fr
authors: Caroline
authors: C
authors: Gaudy-Marqueste
authors: Jean-Marie
authors: JM
authors: Regis
authors: Xavier
authors: X
authors: Muracciole
authors: Renaud
authors: R
authors: Laurans
authors: Marie-Aleth
authors: MA
authors: Richard
authors: Jean-Jacques
authors: JJ
authors: Bonerandi
authors: Jean-Jacques
authors: JJ
authors: Grob