Abstract
BackgroundTo retrospectively access outcome and toxicity of whole brain radiotherapy (WBRT) in patients with multiple brain metastases (BM) from malignant melanoma (MM).Patients and methodsResults of 87 patients (median age 58 years; 35 female, 52 male) treated by WBRT for BM of MM between 2000 and 2011 were reviewed. Total dose applied was either 30 Gy in 10 fractions (n = 56) or 40 Gy in 20 fractions (n = 31). All but 9 patients suffered from extra-cerebral metastases. Prior surgical resection of BM was performed in 18 patients, salvage stereotactic radiosurgery in 13 patients.ResultsMean follow-up was 8 months (range, 0–57 months), the 6- and 12-months overall-(OS) survival rates were 29.2% and 16.5%, respectively. The median OS was 3.5 months. In cerebral follow-up imaging 6 (11) patients showed a complete (partial) remission, while 11 (17) patients had stable disease (intra-cerebral tumor progression). In comparison of total dose, the group treated with 40 Gy in 20 fractions achieved a significant longer OS (p = 0.003, median 3.1 vs. 5.6 months). Furthermore, DS-GPA score (p < 0.001) as well as RPA class (p < 0.001) influenced significantly on OS and patients had a significantly longer OS after surgical resection (p = 0.001, median 3.0 vs. 5.8 months, multivariate p = 0.007). Having extra-cerebral metastases didn't significantly impact on OS (p = 0.21).ConclusionTreatment of BM from MM with WBRT is tolerated well and some remissions of BM could be achieved. An advantage for higher treatment total doses was seen. However, outcome is non-satisfying, and further improvements in treatment of BM from MM are warranted.
Highlights
The malignant melanoma accounts for approximately 4.3% of all cancers in Germany in females and 3.2% in males, respectively and causes around 1% of all cancer deaths
In the present work we focused on patients with cerebral metastases from malignant melanoma to evaluate treatment outcome and toxicity
Remission lead to a significantly improved overall survival (OS) (p < 0.001) with median 13.5 months compared to 4.4 months in patients without remission and 2.4 months in patients without information on imaging outcome
Summary
The malignant melanoma accounts for approximately 4.3% of all cancers in Germany in females and 3.2% in males, respectively and causes around 1% of all cancer deaths. Several other groups have reported high efficacy of SRS for patients with malignant melanoma brain metastases: Seung et al treated 140 lesions in 46 patients, with progression-free rates of 86% at 6 and 76% at 12 months, respectively [19,20]. Our own data published previously was based on 64 patients treated for 122 lesions; in this group, local control was 81% at 12 months, and median survival after treatment was 10.6 months [22]. Another approach would be stereotactic brachytherapy using 125-iodine seeds in solitary brain metastases, giving the advantage of histological evaluation [23]. To retrospectively access outcome and toxicity of whole brain radiotherapy (WBRT) in patients with multiple brain metastases (BM) from malignant melanoma (MM)
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