Clinical outcome of metastatic melanoma involving the CNS with or without (w/o) intracranial hemorrhage (IHC)

Abstract

8577 Background: Melanoma has a high rate of ICH associated with CNS metastasis (mets). There is no data on the clinical outcome of these patients (pts) in the literature. Methods: A retrospective review of 52 pts with melanoma CNS mets diagnosed from 11/2001 to 09/2006 at our institution. Two pts were excluded due to a second malignancy. The clinical, radiological, and pathological characteristics of these pts were reviewed. Results: 39 pts were diagnosed after onset of neurological symptoms and 11 were diagnosed during staging. Of these, 14 (28%) were solitary, 23 (46%) were = 4, and 13 (26%) were multiple brain mets. Mean age at brain mets diagnosis was 55 years (range 24–88). Mean follow-up was 25 months (mos) (range 3–61) and 64% were male. ICH was found in 22 pts (44%) with 13 pts (26%) having frank hemorrhage on cranial CT and/or MRI scan. ICH was less common (9%) in pts with brain mets diagnosed on staging. 11 pts (8 with ICH, 3 w/o ICH) underwent CNS mets resection through craniotomy followed by whole brain radiation (WBRT) and/or stereotactic radiotherapy (STR). 7 pts received best supportive care. The remaining pts received WBRT and/or STR. The median survival (MS) for the entire group from CNS mets diagnosis was 7.6 mos. For pts with ICH, overall MS was 9.6 mos with MS of 21.2 mos for pts who underwent craniotomy vs 2.9 mos for pts w/o craniotomy. One pt refused therapy and later died from frank ICH. For pts w/o ICH, overall MS was 6.0 mos with MS of 21.3 mos for pts who underwent craniotomy vs 4.2 mos for pts w/o craniotomy. Pts who underwent craniotomy followed by WBRT and/or STR fared the best with MS of 21.2 mos. Of these, 2 pts with solitary brain mets (1 with ICH, 1 w/o ICH) were alive with no relapse at 58 and 53 mos respectively. The cause of death was disease progression in almost all pts and 85% of pts died from CNS disease progression. One pt died from post-operative complications of craniotomy. Conclusions: ICH by itself is not associated with a negative clinical outcome with appropriate clinical management. Aggressive surgical resection followed by radiotherapy in selected pts improves clinical outcome with prolonged survival possible in a minority of pts. No significant financial relationships to disclose.