title: Efficacy and toxicity of whole brain radiotherapy in patients with multiple cerebral metastases from malignant melanoma.
abstract: BACKGROUND
  To retrospectively access outcome and toxicity of whole brain radiotherapy (WBRT) in patients with multiple brain metastases (BM) from malignant melanoma (MM).
  
  
  METHODS
  Results of 87 patients (median age 58 years; 35 female, 52 male) treated by WBRT for BM of MM between 2000 and 2011 were reviewed. Total dose applied was either 30 Gy in 10 fractions (n = 56) or 40 Gy in 20 fractions (n = 31). All but 9 patients suffered from extra-cerebral metastases. Prior surgical resection of BM was performed in 18 patients, salvage stereotactic radiosurgery in 13 patients.
  
  
  RESULTS
  Mean follow-up was 8 months (range, 0-57 months), the 6- and 12-months overall-(OS) survival rates were 29.2% and 16.5%, respectively. The median OS was 3.5 months. In cerebral follow-up imaging 6 (11) patients showed a complete (partial) remission, while 11 (17) patients had stable disease (intra-cerebral tumor progression). In comparison of total dose, the group treated with 40 Gy in 20 fractions achieved a significant longer OS (p = 0.003, median 3.1 vs. 5.6 months). Furthermore, DS-GPA score (p < 0.001) as well as RPA class (p < 0.001) influenced significantly on OS and patients had a significantly longer OS after surgical resection (p = 0.001, median 3.0 vs. 5.8 months, multivariate p = 0.007). Having extra-cerebral metastases didn't significantly impact on OS (p = 0.21).
  
  
  CONCLUSIONS
  Treatment of BM from MM with WBRT is tolerated well and some remissions of BM could be achieved. An advantage for higher treatment total doses was seen. However, outcome is non-satisfying, and further improvements in treatment of BM from MM are warranted.
authors.affiliation: Department of Radiation Oncology, University of Heidelberg, INF 400, Heidelberg, 69120, Germany. henrik.hauswald@med.uni-heidelberg.de
authors.forename: Henrik
authors.initials: H
authors.lastname: Hauswald
authors.forename: Jan-Oliver
authors.initials: JO
authors.lastname: Dittmar
authors.forename: Daniel
authors.initials: D
authors.lastname: Habermehl
authors.forename: Stefan
authors.initials: S
authors.lastname: Rieken
authors.forename: Florian
authors.initials: F
authors.lastname: Sterzing
authors.forename: Jürgen
authors.initials: J
authors.lastname: Debus
authors.forename: Stephanie E
authors.initials: SE
authors.lastname: Combs
mesh_terms: D001932:Brain Neoplasms / Q000401:mortality / Q000532:radiotherapy* / Q000556:secondary*; D016371:Cranial Irradiation / Q000009:adverse effects* / Q000379:methods; D018572:Disease-Free Survival; D005260:Female; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D008545:Melanoma / Q000401:mortality / Q000532:radiotherapy* / Q000556:secondary*; D008875:Middle Aged; D011878:Radiotherapy / Q000009:adverse effects; D012189:Retrospective Studies; D012878:Skin Neoplasms / Q000473:pathology*