Multimodality management of brain metastases in metastatic melanoma patients.
Brain metastases are a frequent complication of advanced melanoma. Neurosurgery (generally followed by radiotherapy) may be useful in managing solitary, superficial brain metastases in good performance status patients, as well as for diagnostic purposes. Since most patients are not felt to be resectable and concurrent extracranial metastases frequently are present, whole-brain radiotherapy (WBRT) has become the de facto treatment standard. WBRT has resulted in disappointing outcomes, resulting in a 3.6-4.1-month median survival. Recent studies have suggested that focal irradiation using linear accelerator-based stereotactic radiosurgery or gamma-knife technologies can result in excellent local control and prolonged survival in some patients. It is possible that more aggressive combined modality treatment strategies, such as addition of systemic therapy, may further improve outcome. Current data suggest that aggressive treatment of patients with up to five brain melanoma brain metastases is capable of producing prolonged survival in many patients, including some long-term complete responses.
Section of Melanoma, Renal Cancer & Immunotherapy, Nevada Cancer Institute, One Breakthrough Way, 10441 W. Twain Ave., Las Vegas, NV 89135, USA. wsamlowski@nvcancer.org
Wolfram E
WE
Samlowski
Randy L
RL
Jensen
Dennis C
DC
Shrieve
D000970:Antineoplastic Agents / Q000627:therapeutic use; D001932:Brain Neoplasms / Q000556:secondary* / Q000628:therapy*; D003131:Combined Modality Therapy; D016371:Cranial Irradiation; D006801:Humans; D008545:Melanoma / Q000556:secondary* / Q000628:therapy*; D011379:Prognosis; D012878:Skin Neoplasms / Q000473:pathology*; D016019:Survival Analysis
D000970:Antineoplastic Agents