Factors affecting the outcome after treatment for metastatic melanoma to the brain.
BACKGROUND
Because of the difficulties inherent to the treatment of metastatic melanoma to the brain including high rates of disease progression and local treatment failure, we attempted to determine the prognostic factors that impacted the outcome of these patients, and reviewed patient outcome based on primary treatment with either surgical resection or SRS.


METHODS
A retrospective review identified 37 patients treated for metastatic melanoma between July 2002 and April 2007. Information was obtained documenting systemic disease, preoperative symptoms, tumor size and location, disease recurrence, primary and secondary treatments, and survival time.


RESULTS
Two patients were alive as of March 2008. The median survival time for patients primarily treated with surgical resection was 9.7 months compared to 7.9 months for patients initially treated with SRS. Solitary brain metastases and the absence of both preoperative hemorrhage and lung metastases served as prognostic factors increasing survival in both groups. Four patients undergoing primary treatment with SRS required subsequent surgical intervention secondary to radiation necrosis (3 patients) or local recurrence (1 patient). All 4 had lesions greater than 1.5 cm. For surgical patients, planned postoperative treatment with either radiosurgery or radiation therapy increased survival time to 12.3 months vs 7.3 months.


CONCLUSIONS
Patients with positive prognostic factors including solitary brain lesions, absence of hemorrhage preoperatively, and absence of lung disease are viable candidates for aggressive, surgical intervention followed by adjuvant therapy with radiosurgery or conventional radiation therapy. Other patients should be considered for more conservative treatment with radiosurgery or other palliative treatments.
Carrubba
Christopher J
CJ
Norton Neuroscience Institute, Louisville, KY 40202, USA.
Vitaz
Todd W
TW
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001932:Brain Neoplasms / Q000401:mortality / Q000556:secondary* / Q000601:surgery*; D002540:Cerebral Cortex / Q000601:surgery; D003388:Cranial Fossa, Posterior / Q000601:surgery; D018572:Disease-Free Survival; D005260:Female; D006801:Humans; D008297:Male; D008545:Melanoma / Q000401:mortality / Q000556:secondary* / Q000601:surgery*; D008866:Microsurgery; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000601:surgery; D038361:Neuronavigation; D011183:Postoperative Complications / Q000209:etiology* / Q000401:mortality; D011379:Prognosis; D016634:Radiosurgery; D012086:Reoperation; D012189:Retrospective Studies; D012878:Skin Neoplasms / Q000401:mortality / Q000601:surgery*; D015996:Survival Rate; D016896:Treatment Outcome