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Initial treatment of melanoma brain metastases using gamma knife radiosurgery


Al Musella's Comments: (This is his personal views and are not necessarily the views of the Musella Foundation!)



Website: http://www3.interscience.wiley.com/cgi-bin/abstract/109088622/ABSTRACT

Posted on: 08/10/2004

Initial treatment of melanoma brain metastases using gamma knife radiosurgery

Original Article
An evaluation of efficacy and toxicity

Andrew E. Radbill, M.D. 1, John F. Fiveash, M.D. 2, Elizabeth T. Falkenberg, M.D. 2, Barton L. Guthrie, M.D. 3, Paul E. Young, M.S. 4, Sreelatha Meleth, Ph.D. 5, James M. Markert, M.D. 3 *

1Department of Medicine, Children's Hospital, Boston, Massachusetts 2Department of Radiation Oncology, University of Alabama-Birmingham, Birmingham, Alabama 3Division of Neurosurgery, Department of Surgery, University of Alabama-Birmingham, Birmingham, Alabama 4Gamma Knife Department, HealthSouth Medical Center, Birmingham, Alabama 5Biostatistics Unit, University of Alabama-Birmingham, Birmingham, Alabama

email: James M. Markert (jmarkert@uabmc.edu)

*Correspondence to James M. Markert, Division of Neurosurgery, Department of Surgery, University of Alabama-Birmingham, FOT 1050, 1530 3rd Avenue South, Birmingham, AL 35294-3410

Fax: (205) 975-3203
Funded by:
Student Research Fellowship Award from the Pittman General Clinical Research Center at the University of Alabama School of Medicine

Keywords brain neoplasms • melanoma • metastasis • radiosurgery • treatment outcome

Abstract

BACKGROUND

Melanoma is the primary malignancy that is most likely to metastasize to the brain. Because such an event carries an almost uniformly poor prognosis, the current study reviewed outcomes and identified associated prognostic indicators for 51 consecutive patients receiving gamma knife (GK) radiosurgery in the initial treatment of 188 intracranial melanoma metastases.

METHODS
Data were collected retrospectively from a single-center GK radiosurgery database and from primary patient medical records and radiographs.

RESULTS
At presentation, 71% of patients had multiple intracranial metastases, and extracranial metastases were present in 66% of patients. Thirty-two patients (63%) were initially treated with GK radiosurgery alone, whereas the remainder received GK radiosurgery in combination with surgery and/or whole-brain radiotherapy (WBRT). Overall median survival from time of GK radiosurgery was 26 weeks. Subgroup analysis revealed a median survival of 77 weeks for patients presenting with a single lesion, compared with 20 weeks for patients presenting with multiple lesions (P = 0.003). Patients in recursive partitioning analysis (RPA) Class I survived a median of 57 weeks, compared with a median survival of 20 weeks for patients in RPA Class II or III (P = 0.002). Although long-term imaging follow-up revealed that a majority of patients experienced distant brain metastases, multivariate analysis showed that distant metastases occurred significantly sooner in patients with extracranial metastases (P = 0.0004). Addition of initial WBRT had no significant effect on the time to development of new brain metastases (P = 0.13). Local control (crude) was observed in 81% of lesions initially treated with GK. Patients experienced improved or stable symptoms for a median of 37 weeks post-GK radiosurgery.

CONCLUSIONS
Survival analyses supported the use of GK radiosurgery in the initial treatment of patients with melanoma brain metastases, with best results occurring in patients presenting with a single lesion. Cancer 2004. © 2004 American Cancer Society.

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Received: 15 March 2004; Revised: 13 May 2004; Accepted: 20 May 2004
Digital Object Identifier (DOI)
10.1002/cncr.20447 About DOI



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