title: Asymptomatic brain metastases in patients with cutaneous metastatic malignant melanoma.
abstract: The aim of the study was to identify the frequency of asymptomatic brain metastases detected by computed tomography (CT) scans in patients with metastatic cutaneous melanoma referred to first-line systemic treatment. Between 1995 and 2009, 697 Danish patients were screened with a contrast-enhanced CT scan of the brain before the start of interleukin-2 (IL-2)-based immunotherapy. Among the 697 patients, 80 had asymptomatic brain metastases (12%). Patients' characteristics did not differ significantly between groups with and without brain metastases. Patients received systemic treatment (IL-2-based or cytotoxic chemotherapy), local treatment (stereotactic radiotherapy, whole-brain radiotherapy or surgery), or best supportive care only. The survival was significantly shorter for patients with asymptomatic brain metastases compared with patients without brain metastases (P<0.0001). The median survival was 4.5 versus 9.2 months; 1-year survival was 12.5 versus 38.4% for patients with or without asymptomatic brain metastases, respectively. We conclude that 12% of patients with metastatic cutaneous melanoma who qualified clinically for IL-2 treatment had asymptomatic brain metastases, detected by CT scans with contrast. Proper staging of metastatic cutaneous melanoma including contrast-enhanced CT of neck, thorax, and abdomen and contrast-enhanced MRI of the brain is mandatory, as systemic treatment options with comparable safety and efficacy in patients with and without brain metastases have emerged.
authors.affiliation: Departments of Oncology, Odense University Hospital, Odense, Denmark. ruta.zukauskaite@gmail.com
authors.forename: Ruta
authors.initials: R
authors.lastname: Zukauskaite
authors.forename: Henrik
authors.initials: H
authors.lastname: Schmidt
authors.forename: Jon T
authors.initials: JT
authors.lastname: Asmussen
authors.forename: Olfred
authors.initials: O
authors.lastname: Hansen
authors.forename: Lars
authors.initials: L
authors.lastname: Bastholt
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000970:Antineoplastic Agents / Q000627:therapeutic use; D058070:Asymptomatic Diseases; D001932:Brain Neoplasms / Q000473:pathology / Q000556:secondary* / Q000628:therapy*; D002648:Child; D003287:Contrast Media; D005260:Female; D006801:Humans; D007376:Interleukin-2 / Q000627:therapeutic use; D053208:Kaplan-Meier Estimate; D008279:Magnetic Resonance Imaging; D008297:Male; D008545:Melanoma / Q000556:secondary* / Q000628:therapy*; D008875:Middle Aged; D009367:Neoplasm Staging; D016634:Radiosurgery; D012189:Retrospective Studies; D012878:Skin Neoplasms / Q000473:pathology* / Q000628:therapy*; D015996:Survival Rate; D014057:Tomography, X-Ray Computed; D055815:Young Adult
chemical_list: D000970:Antineoplastic Agents; D003287:Contrast Media; D007376:Interleukin-2