Outcome evaluation of patients with limited brain metastasis from malignant melanoma, treated with surgery, radiation therapy and targeted therapy.

Outcome evaluation of patients with limited brain metastasis from malignant melanoma, treated with surgery, radiation therapy and targeted therapy.

World Neurosurg. 2017 May 31;:

Authors: Pessina F, Navarria P, Tomatis S, Cozzi L, Franzese C, Di Guardo L, Ascolese AM, Reggiori G, Franceschini D, Del Vecchio M, Bello L, Marta Scorsetti

Abstract
OBJECTIVE: The incidence of brain metastases from melanoma is increasing. Several effective treatment options are now available but what can be considered the optimal therapeutic strategy is not yet defined. We evaluated the outcome of brain metastatic melanoma patients in terms of local control rate, brain distant progression and overall survival.
MATERIALS AND METHODS: The present retrospective study includes only patients with limited brain metastases (≤4) underwent surgery plus stereotactic radiosurgery (SRS), or SRS alone. Surgical resection was performed in patients with good KPS, single large brain lesions, controlled extra-cranial disease and SRS alone in all other cases. Supramargical resection was performed in all patients. The prescribed RT doses were 24Gy/1fraction and 30Gy in 3-5 fractions for lesions >2.5 cm. Clinical outcome was evaluated by brain MRI performed two months after RT and then every 3 months.
RESULTS: From April 2011 to October 2015, 53 patients were treated. The median age was 54 years (range 29-82 years). Most of patients had 1-2 BMs (86.8%). Twelve patients (22.6%) underwent surgical resection followed by SRS on the tumor bed, and 41 (77.4%) received SRS alone. The median follow-up time was 20.9 months (5.7-61.3months). The median,1,2,3-year OS were 11.8 months,47.2%, 28%, and 21.8% respectively. Factors recorded as influencing survival were the number of BMs, the melanoma-specific graded prognostic assessment score, and BRAF mutated status.
CONCLUSION: Our data allowed to identify a subset of patients with a more favorable outcome who could take advantage of a more aggressive local approach followed by targeted therapy.

PMID: 28578123 [PubMed - as supplied by publisher]

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