title: Melanoma brain metastases: the impact of nodal disease.
abstract: Brain metastases (BMs) are a major source of mortality and morbidity in patients with melanoma. This study assesses prognostic nodal factors in patients with nodal metastatic melanoma with respect to the development of BMs. The aim was to identify a high risk subset that may benefit from brain directed management. Prospective surgical and clinical trial databases identified patients who had had nodal dissections and were seen through the Princess Alexandra Hospital Melanoma clinic between August 1995 and June 2010. Patient data was collected and event data was updated from medical imaging and clinical records. The primary endpoint was the rate of development of BMs. 474 patients were identified as having nodal dissections. Two hundred and eighty-seven patients (61%) were male with a median age of 52 (39-66). The most common nodal dissection site was axilla 190 (40%), followed by groin 154 (32.5%) and neck 130 (27.5%). Adjuvant radiotherapy to the nodal basin was delivered to 134 patients (28%). BMs occurred in 61 patients (12.9%) with a median time of 13.87 months from dissection. No lymph node characteristics were significantly associated with the development of BMs including: nodal region (p=0.72), nodal size (p=0.08), number of involved nodes (p=0.36), presence of extra-capsular spread (p=0.47) and AJCC N stage. There was no significant association between primary ulceration (p=0.37) or location and development of BMs. It appears that for patients with resected stage III melanoma there is no histopathological lymph node feature associated with the development of BMs. This highlights the importance of identifying molecular markers in nodal melanoma which may predict for BMs to further direct site-specific therapy.
authors: Department of Radiation Oncology, Princess Alexandra Hospital, Ipswich Road, Woolloongabba, QLD, 4102, Australia, jimejackson@gmail.com.
authors: James E
authors: JE
authors: Jackson
authors: Bryan H
authors: BH
authors: Burmeister
authors: Elizabeth A
authors: EA
authors: Burmeister
authors: Matthew C
authors: MC
authors: Foote
authors: Janine M
authors: JM
authors: Thomas
authors: Janelle A
authors: JA
authors: Meakin
authors: B Mark
authors: BM
authors: Smithers
mesh_terms: D000328:Adult; D000368:Aged; D001932:Brain Neoplasms / Q000556:secondary*; D005260:Female; D006801:Humans; D008197:Lymph Node Excision; D008207:Lymphatic Metastasis / Q000473:pathology*; D008297:Male; D008545:Melanoma / Q000556:secondary*; D008875:Middle Aged; D009367:Neoplasm Staging; D021701:Sentinel Lymph Node Biopsy; D012878:Skin Neoplasms; D000096142:Cutaneous Malignant Melanoma
references: Cancer. 1980 Feb 15;45(4):679-83
references: 6766793
references: J Neurooncol. 2008 May;87(3):299-307
references: 18157648
references: Am J Surg. 1978 Jun;135(6):807-10
references: 665907
references: J Clin Oncol. 2005 Sep 1;23(25):6207-19
references: 16135488
references: Neurosurgery. 1981 Jan;8(1):26-30
references: 7207769
references: J Natl Compr Canc Netw. 2009 Mar;7(3):250-75
references: 19401060
references: J Clin Oncol. 2009 Dec 20;27(36):6199-206
references: 19917835
references: BMC Cancer. 2011 Apr 17;11:142
references: 21496312
references: Melanoma Res. 2005 Apr;15(2):119-24
references: 15846145
references: J Neurosurg. 1998 Jan;88(1):11-20
references: 9420067
references: Melanoma Res. 2008 Aug;18(4):268-73
references: 18626311
references: Lancet Oncol. 2012 May;13(5):459-65
references: 22456429
references: Cancer. 2011 Apr 15;117(8):1697-703
references: 21472716
references: J Clin Oncol. 2001 Aug 15;19(16):3622-34
references: 11504744
references: Cancer J. 2012 Mar-Apr;18(2):208-12
references: 22453023
references: Lancet Oncol. 2012 Jun;13(6):589-97
references: 22575589
references: J Clin Oncol. 2010 Jun 20;28(18):3042-7
references: 20479405
references: Head Neck. 1993 Sep-Oct;15(5):377-81
references: 8407308
references: Cancer. 2011 Apr 15;117(8):1711-20
references: 21472718
references: Expert Rev Neurother. 2012 Oct;12(10):1207-15
references: 23082737