Management of Cerebral Metastases from Melanoma Treated at a Single Institution

Abstract

Objective This retrospective study aimed to analyze prognostic factors, effects of treatment, and survival outcome of patients with brain metastasis from melanoma at a single institution over the last 22 years.

Methods Study transversal retrospective of 34 patients with brain metastases from melanoma, histologically proven, surgically treated by the Department of Neurosurgery at the Hospital Santa Isabel, Blumenau, over 22 years.

Results The median patient age was 50 years and 67.6% of the patients were men. Most patients (70.6%) had a single cerebral metastasis and 29.4% had two three injuries. Twenty percent of the patients in this series had evidence of extracranial metastasis. The KPS at presentation was ≥70 in 12 patients (35.2%). Evidence of recurrent intracranial melanoma was found during follow-up review in 17.6% of patients. The overall median survival time from diagnosis of cerebral metastasis was 14.4 months. The absence of extracranial metastasis was associated with a significantly prolonged survival (p = 0.052), as was adjuvant therapy (p = 0.02).

Conclusion The early diagnosis, with total resection of melanoma metastasis and association of adjuvant therapies showed a positive influence on survival. However, the number of lesions and extracranial disease decreased the survival rates.

Resumo

Objetivo O objetivo deste estudo retrospectivo foi analisar os fatores prognósticos, os efeitos do tratamento e a sobrevida de pacientes com metástase cerebral de melanoma em uma única instituição ao longo dos últimos 22 anos.

Métodos Estudo transversal retrospectivo de 34 pacientes com metástases cerebrais de melanoma, histologicamente comprovadas, tratados cirurgicamente pelo Departamento de Neurocirurgia do Hospital Santa Isabel de Blumenau, em 22 anos.

Resultados A média de idade dos pacientes foi de 50 anos e 67,6% deles eram homens. A maioria dos pacientes (70,6%) tinha uma única metástase cerebral e 29,4% tiveram duas e três lesões; 20% dos pacientes desta série apresentaram evidência de metástase extracraniana. O KPS na apresentação foi ≥70 em 12 pacientes (35,2%). Evidência de recidiva intracraniana foi encontrada durante a revisão em 17,6 % dos pacientes. O tempo de sobrevida global média do diagnóstico de metástase cerebral foi de 14,4 meses. A ausência de metástases extracranianas foi associada a uma sobrevida significativamente maior (p = 0,052), assim como a terapia adjuvante (p = 0,02).

Conclusão O diagnóstico precoce, a ressecção total da metástase do melanoma e a associação de terapias adjuvantes mostraram um efeito positivo sobre a sobrevida. Por outro lado, o número de lesões e de doenças extracranianas diminuiu as taxas de sobrevida.

Keywords

metastatic melanoma - brain metastases - neurosurgery

Palavras-chave

melanoma metastático - metástase cerebral - neurocirurgia

• References

• 1 Staudt M, Lasithiotakis K, Leiter U , et al. Determinants of survival in patients with brain metastases from cutaneous melanoma. Br J Cancer 2010; 102 (8) 1213-1218
• 2 Ranasinghe MG, Sheehan JM. Surgical management of brain metastases. Neurosurg Focus 2007; 22 (3) E2
• 3 Sloan AE, Nock CJ, Einstein DB. Diagnosis and treatment of melanoma brain metastasis: a literature review. Cancer Contr 2009; 16 (3) 248-255
• 4 Wroński M, Arbit E. Surgical treatment of brain metastases from melanoma: a retrospective study of 91 patients. J Neurosurg 2000; 93 (1) 9-18
• 5 Zacest AC, Besser M, Stevens G, Thompson JF, McCarthy WH, Culjak G. Surgical management of cerebral metastases from melanoma: outcome in 147 patients treated at a single institution over two decades. J Neurosurg 2002; 96 (3) 552-558
• 6 Eigentler TK, Figl A, Krex D , et al; Dermatologic Cooperative Oncology Group and the National Interdisciplinary Working Group on Melanoma. Number of metastases, serum lactate dehydrogenase level, and type of treatment are prognostic factors in patients with brain metastases of malignant melanoma. Cancer 2011; 117 (8) 1697-1703
• 7 Lonser RR, Song DK, Klapper J , et al. Surgical management of melanoma brain metastases in patients treated with immunotherapy. J Neurosurg 2011; 115 (1) 30-36
• 8 Javalkar V, Cardenas R, Ampil F, Ahmed O, Shi R, Nanda A. The Louisiana State University experience in the management of single small cerebellar metastasis. Neurosurgery 2010; 67 (6) 1515-1522
• 9 Sheehan J, Sheehan J. Changing paradigms for the treatment of brain metastasis. Neurosurg Focus 2007; 22 (3) E (Intro)
• 10 Nieder C, Marienhagen K, Geinitz H, Grosu AL. Can current prognostic scores reliably guide treatment decisions in patients with brain metastases from malignant melanoma?. J Cancer Res Ther 2011; 7 (1) 47-51
• 11 Sampson JH, Carter Jr JH, Friedman AH, Seigler HF. Demographics, prognosis, and therapy in 702 patients with brain metastases from malignant melanoma. J Neurosurg 1998; 88 (1) 11-20
• 12 Choi KN, Withers HR, Rotman M. Intracranial metastases from melanoma. Clinical features and treatment by accelerated fractionation. Cancer 1985; 56 (1) 1-9
• 13 Fife KM, Colman MH, Stevens GN , et al. Determinants of outcome in melanoma patients with cerebral metastases. J Clin Oncol 2004; 22 (7) 1293-1300
• 14 Liew DN, Kano H, Kondziolka D , et al. Outcome predictors of Gamma Knife surgery for melanoma brain metastases. J Neurosurg 2011; 114 (3) 769-779
• 15 Morris SL, Low SH, A'Hern RP , et al. A prognostic index that predicts outcome following palliative whole brain radiotherapy for patients with metastatic malignant melanoma. Br J Cancer 2004; 91 (5) 829-833
• 16 Sperduto PW, Kased N, Roberge D , et al. Summary report on the graded prognostic assessment: an accurate and facile diagnosis-specific tool to estimate survival for patients with brain metastases. J Clin Oncol 2012; 30 (4) 419-425
• 17 Raizer JJ, Hwu WJ, Panageas KS , et al. Brain and leptomeningeal metastases from cutaneous melanoma: survival outcomes based on clinical features. Neuro Oncol 2008; 10 (2) 199-207
• 18 Davies MA, Liu P, McIntyre S , et al. Prognostic factors for survival in melanoma patients with brain metastases. Cancer 2011; 117 (8) 1687-1696
• 19 Moser RP, Johnson ML. Surgical management of brain metastases: how aggressive should we be?. Oncology (Williston Park) 1989; 3 (6) 123-127 , discussion 128, 134
• 20 Brand CU, Ellwanger U, Stroebel W , et al. Prolonged survival of 2 years or longer for patients with disseminated melanoma. An analysis of related prognostic factors. Cancer 1997; 79 (12) 2345-2353
• 21 Brega K, Robinson WA, Winston K, Wittenberg W. Surgical treatment of brain metastases in malignant melanoma. Cancer 1990; 66 (10) 2105-2110
• 22 Mintz AH, Kestle J, Rathbone MP , et al. A randomized trial to assess the efficacy of surgery in addition to radiotherapy in patients with a single cerebral metastasis. Cancer 1996; 78 (7) 1470-1476
• 23 Noordijk EM, Vecht CJ, Haaxma-Reiche H , et al. The choice of treatment of single brain metastasis should be based on extracranial tumor activity and age. Int J Radiat Oncol Biol Phys 1994; 29 (4) 711-717
• 24 Patchell RA, Tibbs PA, Walsh JW , et al. A randomized trial of surgery in the treatment of single metastases to the brain. N Engl J Med 1990; 322 (8) 494-500