Brain metastasis from melanoma: the prognostic value of varying sites of extracranial disease.
Patients with brain metastasis from melanoma have poor outcomes. Radiation is used both for prognostic and symptomatic value. We aimed to further clarify the role of stereotactic radiosurgery (SRS) and whole brain radiotherapy (WBRT) as well as the prognostic implication of various sites of extracranial disease. The records of 73 consecutive patients treated at the University of Rochester Medical Center for brain-metastatic melanoma from January 2004 to October 2013 were reviewed. The median overall survival (OS) was 3.0 months. Patients treated with WBRT alone had decreased OS compared to those treated with SRS alone (HR = 0.38, p = 0.001) or WBRT and SRS (HR = 0.51, p = 0.039). The mean number of brain metastasis differed (p = 0.002) in patients in patients who received WBRT (4.0) compared to those who did not (2.0). Among patients with extracranial disease (n = 63), bone metastasis (HR = 1.86, p = 0.047, n = 15) was a negative prognostic factor; liver (HR = 1.59, p = 0.113, n = 17), lung (HR = 1.51, p = 0.23, n = 51) and adrenal metastasis (HR = 1.70, p = 0.15, n = 10) were not. In patients with concurrent brain and lung metastasis, those with disease limited to those two sites (OS = 8.7 mo, n = 13) had improved OS (HR = 0.44, p = 0.014) compared to those with additional disease (OS = 1.8 mo, n = 50). Based on this hypothesis-generating retrospective analysis, SRS may offer survival benefit compared to WBRT alone in patients with brain metastatic melanoma. Bone metastasis appears to confer a particularly poor prognosis. Those with disease confined to the lung and brain may represent a population with improved prognosis.
Department of Radiation Oncology, University of Rochester Medical Center, 601 Elmwood Avenue, Rochester, NY, 14642, USA.
James E
JE
Bates
Department of Radiation Oncology, University of Rochester Medical Center, 601 Elmwood Avenue, Rochester, NY, 14642, USA.
Paul
P
Youn
Department of Radiation Oncology, University of Rochester Medical Center, 601 Elmwood Avenue, Rochester, NY, 14642, USA.
Kenneth Y
KY
Usuki
Department of Neurosurgery, University of Rochester Medical Center, 601 Elmwood Avenue, Rochester, NY, 14642, USA.
Kevin A
KA
Walter
Department of Radiation Oncology, University of Rochester Medical Center, 601 Elmwood Avenue, Rochester, NY, 14642, USA.
Christine F
CF
Huggins
Department of Radiation Oncology, College of Medicine, University of Florida, 2000 SW Archer Road, Gainesville, FL, 32610, USA.
Paul
P
Okunieff
Department of Radiation Oncology, University of Rochester Medical Center, 601 Elmwood Avenue, Rochester, NY, 14642, USA. Michael_Milano@urmc.rochester.edu.
Michael T
MT
Milano
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001921:Brain / Q000473:pathology* / Q000601:surgery; D001932:Brain Neoplasms / Q000175:diagnosis / Q000556:secondary / Q000628:therapy; D016371:Cranial Irradiation; D005260:Female; D006801:Humans; D017567:Karnofsky Performance Status; D008279:Magnetic Resonance Imaging; D008297:Male; D008545:Melanoma / Q000473:pathology*; D008875:Middle Aged; D011379:Prognosis; D016634:Radiosurgery / Q000379:methods*; D012189:Retrospective Studies; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome
Brain metastasis; Limited metastasis; Melanoma; Oligometastasis; Radiosurgery; SRS