title: Prognostic factors for overall survival after radiosurgery for brain metastases from melanoma.
abstract: OBJECTIVE
  Brain metastases (BM) cause significant morbidity and mortality in patients with melanoma. We aimed to identify prognostic factors for overall survival (OS) in patients undergoing stereotactic radiosurgery (SRS) for BM from melanoma.
  
  
  METHODS
  We identified 135 patients treated with SRS at Emory University between 1998 and 2010 for BM from melanoma. We recorded patient age, number and size of all BM, Karnofsky Performance Status (KPS), presence of extracranial metastases, serum lactate dehydrogenase (LDH), use of whole-brain radiation therapy (WBRT), use of temozolomide, and surgical resection of BM. We used the Kaplan-Meier method to calculate OS, and we compared time-to-event data with the log-rank test. We performed Cox multivariate analysis to identify factors independently associated with OS.
  
  
  RESULTS
  Median OS for all patients was 6.9 months. Patients with KPS ≥ 90, 70 to 80, and <70 had median OS of 10.4, 6.1, and 4.5 months, respectively (P=0.02). Patients with LDH<240 had median OS of 7.8 months versus 3.5 months for LDH ≥ 240 (P=0.01). Patients receiving WBRT had median OS of 7.3 months versus 6.5 months for patients not receiving WBRT (P=0.05). KPS and LDH (but not WBRT) were significantly associated with OS on multivariate analysis.
  
  
  CONCLUSIONS
  In addition to previously identified prognostic factors for OS in patients with BM from melanoma, serum LDH is independently associated with OS. If this finding is confirmed in a prospective manner, the serum LDH level should be included in future prognostic algorithms for patients with melanoma and BM who are to receive SRS.
authors: Departments of *Radiation Oncology ‡Surgery §Hematology/Oncology †Winship Cancer Institute, Emory University, Atlanta, GA.
authors: David M
authors: DM
authors: Marcus
authors: Michael
authors: M
authors: Lowe
authors: Mohammad K
authors: MK
authors: Khan
authors: David H
authors: DH
authors: Lawson
authors: Ian R
authors: IR
authors: Crocker
authors: Joseph W
authors: JW
authors: Shelton
authors: Alisa
authors: A
authors: Melton
authors: Necia
authors: N
authors: Maynard
authors: Keith A
authors: KA
authors: Delman
authors: Grant W
authors: GW
authors: Carlson
authors: Monica
authors: M
authors: Rizzo
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D018906:Antineoplastic Agents, Alkylating / Q000627:therapeutic use; D001932:Brain Neoplasms / Q000401:mortality / Q000556:secondary* / Q000601:surgery*; D015331:Cohort Studies; D003606:Dacarbazine / Q000031:analogs & derivatives / Q000627:therapeutic use; D005260:Female; D006801:Humans; D053208:Kaplan-Meier Estimate; D007770:L-Lactate Dehydrogenase / Q000097:blood*; D008297:Male; D008545:Melanoma / Q000401:mortality / Q000556:secondary* / Q000601:surgery*; D008875:Middle Aged; D015999:Multivariate Analysis; D011379:Prognosis; D016016:Proportional Hazards Models; D016634:Radiosurgery / Q000379:methods*; D011878:Radiotherapy / Q000706:statistics & numerical data; D012189:Retrospective Studies; D012878:Skin Neoplasms / Q000473:pathology*; D000077204:Temozolomide; D055815:Young Adult
chemical_list: D018906:Antineoplastic Agents, Alkylating; D003606:Dacarbazine; D007770:L-Lactate Dehydrogenase; D000077204:Temozolomide