Brain metastases from melanoma: is there a role for concurrent temozolomide in addition to whole brain radiation therapy?
OBJECTIVE
This study was performed to evaluate the addition of temozolomide (TMZ) to whole brain radiotherapy (WBRT) for brain metastases from melanoma.


METHODS
Seven patients with brain metastases from melanoma were treated on a North Central Cancer Treatment Group (NCCTG) trial (N0274) of TMZ plus WBRT. TMZ was given orally in doses of 200 mg/m² for 5 days every 4 weeks for up to 8 cycles. WBRT was started on the first day of TMZ and included the delivery of 3750 cGy in 15 fractions. In addition, separately analyzed was a cohort of 53 patients treated at the Mayo Clinic who received WBRT alone (39 patients) or WBRT plus TMZ (14 patients).


RESULTS
The median survival of the 7 patients treated on N0274 was 3.6 months with 2 of 7 (29%) failing in brain and 5 of 7 (71%) failing elsewhere. For the other cohort of 53 patients, the median survival was 3.8 months with WBRT alone compared 4.3 months for WBRT plus TMZ (P = 0.5).


CONCLUSIONS
Patients did not appear to benefit from the addition of TMZ to WBRT for the treatment of their brain metastases. Further improvements in outcome will require research to discover more effective systemic therapy and RT techniques.
Schild
Steven E
SE
Department of Radiation Oncology, Mayo Clinic, Scottsdale, AZ 85259, USA. sschild@mayo.edu
Behl
Deepti
D
Markovic
Svetomir N
SN
Brown
Paul D
PD
Sande
Jonathan R
JR
Deming
Richard L
RL
Rowland
Kendrith M
KM
Bearden
James D
JD
D000284:Administration, Oral; D000368:Aged; D000970:Antineoplastic Agents / Q000008:administration & dosage; D001932:Brain Neoplasms / Q000401:mortality / Q000556:secondary* / Q000628:therapy*; D015331:Cohort Studies; D003131:Combined Modality Therapy; D016371:Cranial Irradiation / Q000379:methods*; D003606:Dacarbazine / Q000008:administration & dosage / Q000031:analogs & derivatives*; D004334:Drug Administration Schedule; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D008545:Melanoma / Q000401:mortality / Q000556:secondary* / Q000628:therapy*; D008875:Middle Aged; D011879:Radiotherapy Dosage; D012189:Retrospective Studies; D018570:Risk Assessment; D012878:Skin Neoplasms / Q000401:mortality / Q000473:pathology* / Q000628:therapy; D016019:Survival Analysis; D000077204:Temozolomide; D016896:Treatment Outcome
D000970:Antineoplastic Agents; D003606:Dacarbazine; D000077204:Temozolomide