Stereotactic radiosurgery with or without whole brain radiotherapy for patients with one to three melanoma brain metastases

Abstract

Melanoma brain metastasis poses a difficult ther- apeutic challenge. Melanoma is perceived as a radioresistant histology and is thought to be less responsive to whole brain radiotherapy (WBRT). Stereotactic radiosurgery (SRS) is regarded as one of the treatment options that may improve local control in patients with a small number of lesions. A total of 28 patients with one to three brain metastases from melanoma primary (43 lesions) were treated with Gamma Knife-based SRS. Eight patients received WBRT. The me- dian marginal dose to the lesions was 20 Gy (range 15- 22 Gy) delivered to the 50% isodose line. The cumulative treatment volume ranged from 0.587 to 24.00 ml (median 4.0). Median follow-up for patients was 5.9 months (range 1.3 to 30.9 months). The 3-, 6-, and 12-month overall survival (OS) rates were 78.6%, 52.4%, and 26.4%, respectively, for the whole group. The corresponding free- dom from local progression (FFLP) rates were 78.5%, 68.7%, and 61.1%. The corresponding free from distant brain failure (FFDBF) and free from intracranial failure (FFICF) rates were 71.7%, 47.5%, and 36.9% and 68.9%, 51.7%, and 28.2%, respectively. The addition of WBRT did not impact on OS, FFLP, FFDBF, or FFICF. In patients who are reliable for close follow-up with serial MRI of the brain, SRS alone may be presented as a treatment option. The role of WBRT in patients with limited melanoma brain metasta- ses would be best answered in a phase III randomized trial setting.