Abstract
IntroductionMalignant melanoma is the third most common primary in the diagnosis of brain metastases. Stereotactic radiosurgery (SRS) is a well-established treatment option in limited brain disease. We analyzed outcomes of SRS with a particular focus on the graded prognostic assessment (GPA, melanoma molGPA), prognostic factors, and toxicity.MethodsWe evaluated 173 brain metastases in 83 patients with malignant melanoma. All were treated with SRS median dose of 20 Gy prescribed to the 80 or 100% isodose line between 2002 and 2019. All patients were followed-up regularly, including contrast‐enhanced brain imaging as well as clinical examination, initially 6 weeks after treatment, then in quarterly follow-up.ResultsThe median age was 61 years (range 27–80); 36 female and 47 male patients were treated. After a median follow-up of 5.7 months, median OS (overall survival) was 9.7 months 95%-KI 4.7–14.7). LC (local control) at 6 months, 12, 24 months was 89%, 86%, and 72%, respectively (median was not reached). Median DBC (distant brain control) was 8.2 months (95%-KI 4.7–11.7). For OS, a KPS ≥ 80%, a positive BRAF mutation status, a small PTV (planning target volume), the absence of extracranial metastases, as well as a GPA and melanoma molGPA > 2 were prognostic factors. In the MVA, a small PTV and a melanoma molGPA > 2 remained significant.ConclusionThe present survival outcomes support the use of the disease-specific melanoma molGPA as reliable prognostic score. Favorable outcomes for SRS compared to other studies were observed. In the treatment of brain metastases of malignant melanoma patients, a multidisciplinary approach consisting of surgery, SRS, chemotherapy, and immunotherapy should be considered.
Highlights
Malignant melanoma is the third most common primary in the diagnosis of brain metastases
The graded prognostic assessment (GPA) was developed as a new score in 2008 and based on an analysis of 1960 patients whose data were extracted from the Radiation Therapy Oncology Group (RTOG) database
The present study aimed to identify outcomes and prognostic factors of melanoma patients with brain metastasis
Summary
Malignant melanoma is the third most common primary in the diagnosis of brain metastases. For OS, a KPS ≥ 80%, a positive BRAF mutation status, a small PTV (planning target volume), the absence of extracranial metastases, as well as a GPA and melanoma molGPA > 2 were prognostic factors. The treatment of brain metastases relies on local strategies, including surgery, stereotactic radiosurgery (SRS), as well as on whole-brain radiation (WBRT). First-line treatment decisions in patients with newly diagnosed brain metastases mainly rely on the primary tumor, number and size of brain metastases and Karnofsky performance score (KPS), which are considered in the newly established graded prognostic assessment (GPA). Based on a retrospective study of > 4000 patients with brain metastases, Sperduto et al determined various prognostic factors depending on the histology of the primary and modified the GPA to so-called disease-specific GPA (dsGPA) scores. For patients with malignant melanoma, the updated prognostic score is a further development of the GPA—the so-called melanoma molGPA—is a more complex assessment, which includes the BRAF mutation status [5,6,7]
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