title: Multimodality treatment of melanoma brain metastases incorporating stereotactic radiosurgery (SRS).
abstract: BACKGROUND
  Brain metastases are a frequent complication in advanced melanoma. A 3.6 to 4.1-month median survival has been reported after treatment with whole brain radiotherapy. We performed a retrospective analysis of our institutional experience of multimodality treatment utilizing linear accelerator (Linac)-based stereotactic radiosurgery (SRS).
  
  
  METHODS
  Forty-four melanoma patients with brain metastases underwent 66 SRS treatments for 156 metastatic foci between 1999 and 2004. Patients were treated with initial SRS if <or=5 brain metastases were present. All patients had Karnofsky Performance Status (KPS)>or=70, but 37 patients had active systemic metastases (Recursive Partition Analysis Class 2). Survival was calculated from the time of diagnosis of brain metastases. Minimum follow-up was 1 year after SRS. The potential role of prognostic factors on survival was evaluated including age, sex, interval from initial diagnosis to brain metastases, surgical resection, addition of whole brain radiotherapy (WBRT), number of initial metastases treated, and number of SRS treatments using Cox univariate analysis.
  
  
  RESULTS
  The median survival of melanoma patients with brain metastases was 11.1 months (95% confidence interval [CI]: 8.2-14.9 months) from diagnosis. One-year and 2-year survivals were 47.7% and 17.7%, respectively. There was no apparent effect of age or sex. Surgery or multiple stereotactic radiotherapy treatments were associated with prolonged survival. Addition of WBRT to maintain control of brain metastases in a subset of patients did not improve survival.
  
  
  CONCLUSIONS
  Our results suggest that aggressive treatment of patients with up to 5 melanoma brain metastases including SRS appears to prolong survival. Subsequent chemotherapy or immunotherapy after SRS may have contributed to the observed outcome.
authors.affiliation: Huntsman Cancer Institute, University of Utah, Salt Lake City, Utah 84112, USA. wolfram.samlowski@hci.utah.edu
authors.forename: Wolfram E
authors.initials: WE
authors.lastname: Samlowski
authors.forename: Gordon A
authors.initials: GA
authors.lastname: Watson
authors.forename: Michael
authors.initials: M
authors.lastname: Wang
authors.forename: Ganesh
authors.initials: G
authors.lastname: Rao
authors.forename: Paul
authors.initials: P
authors.lastname: Klimo
authors.forename: Kenneth
authors.initials: K
authors.lastname: Boucher
authors.forename: Dennis C
authors.initials: DC
authors.lastname: Shrieve
authors.forename: Randy L
authors.initials: RL
authors.lastname: Jensen
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use; D001932:Brain Neoplasms / Q000401:mortality / Q000556:secondary* / Q000628:therapy*; D003131:Combined Modality Therapy; D005260:Female; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D008545:Melanoma / Q000401:mortality / Q000556:secondary* / Q000628:therapy*; D008875:Middle Aged; D016634:Radiosurgery; D012878:Skin Neoplasms / Q000473:pathology