Abstract
Background: Brain metastases account for 20–54% of reported deaths from melanoma. Duration and quality of survival depend on the extent of metastatic disease and response to treatment. Treatment goals are palliation of symptoms and prolongation of life. No studies have directly compared surgery alone and surgery with adjunctive cranial irradiation in patients with solitary brain metastases.
Methods: We evaluated postoperative adjunctive cranial irradiation in 34 patients with solitary brain metastases.
Results: Overall survival was significantly improved in the 22 patients who received adjunctive cranial irradiation versus that in the 12 patients who had surgery alone. Twenty-eight patients subsequently relapsed. Nine of 10 patients with surgery alone had brain recurrence as a component of failure. Six of 10 patients not receiving irradiation had brain recurrences as a component of relapse at multiple sites whereas only 1 of 18 patients receiving irradiation relapsed with the brain.
Conclusions: Adjunctive cranial irradiation is justified for melanoma patients who undergo surgical therapy for solitary brain metastases. Survival in patients presenting with solitary brain metastases was improved by a reduction of relapse in the brain as a component of failure by combined surgery and irradiation.
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References
Sawaya R, Ligon L, Bindal RK. Management of metastatic brain tumors.Ann Surg Oncol 1994;1:169–78.
Adair FE. Treatment of melanoma: report of four hundred cases.Surg Gynecol Obstet 1936;62:406–8.
Budman DR, Camacho E, Wittes RE. The current causes of death in patients with malignant melanoma.Eur J Cancer 1978;14:327–30.
Patel JK, Didolkar MS, Pickren JW, Moore RH. Metastatic pattern of malignant melanoma: a study of 216 autopsy cases.Am J Surg 1978;135:807–10.
Amer MH, Al-Sarray M, Baker LH, Vaitkevicius VK. Malignant melanoma and central nervous system metastases.Cancer 1977;42:660–7.
Balch CM, Soong SJ, Murad TM, Smith JW, Maddox WA, Durant JR. A multifactorial analysis of melanoma IV: prognostic factors in 200 melanoma patients with distant metastases (stage III).J Clin Oncol 1983;1:126–34.
Fletcher JW, George EA, Henry RE, Donati RM. Brain scans, dexamethasone therapy, and brain tumors.JAMA 1975;232:1261–3.
Posner JB. Management of central nervous system metastases.Semin Oncol 1977;4:81–91.
Byrne TN, Cascino TL, Posner JB. Brain metastasis from melanoma.J Neurooncol 1983;1:313–7.
Carella RJ, Gelber R, Hendrickson F, Jerry HC, Cooper JS. Value of radiation therapy in the management of patients with cerebral metastases from malignant melanoma.Cancer 1980;45:679–83.
Fernandez E, Maria G, Puca A, Vignati A. Multiple intracranial metastases of malignant melanoma with long term survival.J Neurosurg 1980;34:735.
Cooper JS, Carella R. Radiotherapy of intracerebral metastases melanoma.Radiology 1980;134:735–8.
Gottlieb JA, Frei E III, Luce JK. An evaluation of the management of patients with cerebral metastases from melanoma.Cancer 1972;29:701–5.
Das Gupta T, Brasfield R. Metastatic melanoma.Cancer 1964;17:1323–39.
Brega K, Robinson WA, Winston K, Wittenberg W. Surgical treatment of brain metastases in malignant melanoma.Cancer 1990;10:2105–9.
Fell DA, Leavens ME, McBride CM. Surgical versus nonsurgical management of metastatic melanoma of the brain.Neurosurgery 1980;7:238–42.
Guazzo EP, Atkinson RL, Weidemann M, Effeney DJ. Management of solitary melanoma metastases of the brain.Aust NZ Surg 1989;59:321–4.
McNeel DP, Leavens ME. Long term survival with recurrent metastatic intracranial melanoma: case report.J Neurosurg 1968;29:91–3.
Neuss M, Koning A, Hermann HI. Intracranial melanoma metastases: surgical treatment and follow-up of 18 patients.Anticancer Res 1987;7:445–6.
Lang EF, Slater J. Metastastic brain tumors: results of surgical and non surgical treatment.Surg Clin North Am 1964;44:865–72.
Bauman ML, Price TR. Intracranial metastastic malignant melanoma: long-term survival following subtotal resection.South J Med 1972;65:344–6.
McCann KWP, Weir BKA, Eldridge AR. Long term survival after removal of metastatic malignant melanoma of the brain: report of two cases.J Neurosurg 1968;28:483–7.
Hagen NA, Cirrincione C, Thaler HT, DeAngelis LM. The role of radiation therapy following resection of single brain metastasis from melanoma.Neurology 1990;40:158–60.
Galicich JH, Sundaresan N, Arbit E, Parse E. Surgical treatment of single brain metastasis: factors associated with survival.Cancer 1980;45:381–6.
Katz HR. The relative effectiveness of radiation therapy, corticosteroids, and surgery in the management of melanoma to the central nervous system.Int J Radiat Oncol Biol Phys 1981;7:897–906.
Kalbfleisch JD, Prentice RL.The statistical analysis of failure time data. New York: John Wiley and Sons, 1980.
Dangelis LM, Mandell LR, Thaler HT, et al. The role of postoperative radiotherapy after resection of single brain metastases.Neurosurgery 1989;24:798–805.
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Skibber, J.M., Soong, Sj., Austin, L. et al. Cranial irradiation after surgical excision of brain metastases in melanoma patients. Annals of Surgical Oncology 3, 118–123 (1996). https://doi.org/10.1007/BF02305789
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DOI: https://doi.org/10.1007/BF02305789