title: Stereotactic Radiosurgery for Melanoma Brain Metastases: A Comprehensive Clinical Case Series.
abstract: BACKGROUND
  Melanoma has high propensity to metastasize to the brain. With recent gains in improving patient survival, stereotactic radiosurgery (SRS) may offer an effective and less neurotoxic alternative to whole-brain radiation. In the study, we report on the safety and efficacy of SRS in treating melanoma brain metastases in 87 patients.
  
  
  METHODS
  This retrospective multicenter study examined 87 patients with 309 metastases who underwent single-dose or multifractionated SRS for treatment of intracranial metastases from malignant melanoma.
  
  
  RESULTS
  A total of 87 patients with a median age of 62 years (26-85) were treated from 2007-2014. Eighty patients (92%) also had extracranial metastases at time of treatment, and 69 patients (79%) had uncontrolled systemic disease. Seventy-nine patients (91%) underwent single-dose fractions, 7 (8%) underwent 3 fractions, and 1 (1%) was treated in 5 fractions. The mean tumor volume (GTV) treated was 1.92 cc. Five patients developed symptoms of acute phase toxicity, and 4 developed late phase toxicity. None had radionecrosis. The median survival was 6 months. The Kaplan-Meier 1-year survival rate was 31%, and the 1-year local control rate was 91%. The 1-year survival rate for BRAF-positive patients was 42%, and for BRAF-negative patients it was 27%. Forty-two patients (48%) had distant intracranial recurrences, and 1-year distant control rate was 32%.
  
  
  CONCLUSIONS
  SRS is a safe and effective treatment option for intracranial metastases from malignant melanoma. This paper serves as a reference for what is achievable in the absence of highly effective systemic therapy.
authors.affiliation: Department of Neurosurgery, Icahn School of Medicine at Mount Sinai, New York, New York, USA.
authors.forename: Rui
authors.initials: R
authors.lastname: Feng
authors.affiliation: Department of Neurosurgery, Icahn School of Medicine at Mount Sinai, New York, New York, USA.
authors.forename: Eric K
authors.initials: EK
authors.lastname: Oermann
authors.affiliation: Department of Neurosurgery, Icahn School of Medicine at Mount Sinai, New York, New York, USA.
authors.forename: Raj
authors.initials: R
authors.lastname: Shrivastava
authors.affiliation: Department of Neurosurgery, Icahn School of Medicine at Mount Sinai, New York, New York, USA.
authors.forename: Ariel
authors.initials: A
authors.lastname: Gold
authors.affiliation: Department of Radiation Medicine, Georgetown University School of Medicine, Washington, D.C., USA.
authors.forename: Brian T
authors.initials: BT
authors.lastname: Collins
authors.affiliation: Department of Neurosurgery, New York University School of Medicine, New York, New York, USA; Department of Radiation Oncology, New York University School of Medicine, New York, New York, USA.
authors.forename: Douglas
authors.initials: D
authors.lastname: Kondziolka
authors.affiliation: Department of Radiation Medicine, Georgetown University School of Medicine, Washington, D.C., USA. Electronic address: spc9@georgetown.edu.
authors.forename: Sean P
authors.initials: SP
authors.lastname: Collins
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001932:Brain Neoplasms / Q000401:mortality / Q000532:radiotherapy* / Q000556:secondary*; D015984:Causality; D015897:Comorbidity; D018572:Disease-Free Survival; D004219:District of Columbia / Q000453:epidemiology; D005260:Female; D006801:Humans; D008297:Male; D008545:Melanoma / Q000401:mortality / Q000532:radiotherapy* / Q000556:secondary*; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000401:mortality* / Q000517:prevention & control; D009518:New York / Q000453:epidemiology; D015995:Prevalence; D011832:Radiation Injuries / Q000401:mortality*; D016634:Radiosurgery / Q000379:methods / Q000401:mortality*; D012189:Retrospective Studies; D012307:Risk Factors; D015996:Survival Rate; D016896:Treatment Outcome
keywords: Brain metastasis; Melanoma; Stereotactic radiosurgery