open access

Vol 66, No 5 (2016)
Original articles
Published online: 2017-03-29
Get Citation

The effectiveness of brain metastases radiotherapy in patients with melanoma

Bogumiła Szyszka-Charewicz
DOI: 10.5603/NJO.2016.0066
·
Nowotwory. Journal of Oncology 2016;66(5):367-374.

open access

Vol 66, No 5 (2016)
Original articles
Published online: 2017-03-29

Abstract

Introduction. Melanoma gives rise to 7–13% brain metastases (MBM — melanoma brain metastases) and is ranked third leading cause of brain metastases. The prognosis of patients with MBM is poor, with a median survival time of 3–6 months. Assessment of the value and limitations of three prognostic scores used in patients with melanoma brain metastases (MBM) was presented in this paper.

Material and methods. In 110 patients with MBM, we executed an analysis of prognostic factors. All patients were treated with radiotherapy: whole brain radiotherapy performed as a treatment method in combination with chemotherapy (14 patients — 12.7%), neurosurgery (12 patients — 10.9% or stereotactic radiosurgery (8 patients — 7.3%).

Results. The median overall survival (OS) from diagnosis MBM was 4.8 months (95% CI 4.1–5.2 months). The analyses showed that the Karnofsky Performance Status and number of the MBM are independent significant prognostic factors. The analyses of OS, as a function of prognostic scores, showed that in the class with the best prognosis median OS was similar (7.2–10.7 months); and in the class with the worse prognosis median OS was also similar (range, 2.6–4.3 months).

Conclusions. Our observations and data from literature showed that the presented scores can: distinguish classes of patients by prognosis before treatment, guide the choice of treatment methods and help design strategies for patient selection in clinical trials but they did not fully discriminate between unfavourable groups.

Abstract

Introduction. Melanoma gives rise to 7–13% brain metastases (MBM — melanoma brain metastases) and is ranked third leading cause of brain metastases. The prognosis of patients with MBM is poor, with a median survival time of 3–6 months. Assessment of the value and limitations of three prognostic scores used in patients with melanoma brain metastases (MBM) was presented in this paper.

Material and methods. In 110 patients with MBM, we executed an analysis of prognostic factors. All patients were treated with radiotherapy: whole brain radiotherapy performed as a treatment method in combination with chemotherapy (14 patients — 12.7%), neurosurgery (12 patients — 10.9% or stereotactic radiosurgery (8 patients — 7.3%).

Results. The median overall survival (OS) from diagnosis MBM was 4.8 months (95% CI 4.1–5.2 months). The analyses showed that the Karnofsky Performance Status and number of the MBM are independent significant prognostic factors. The analyses of OS, as a function of prognostic scores, showed that in the class with the best prognosis median OS was similar (7.2–10.7 months); and in the class with the worse prognosis median OS was also similar (range, 2.6–4.3 months).

Conclusions. Our observations and data from literature showed that the presented scores can: distinguish classes of patients by prognosis before treatment, guide the choice of treatment methods and help design strategies for patient selection in clinical trials but they did not fully discriminate between unfavourable groups.

Get Citation

Keywords

melanoma, brain metastases, prognostic index

About this article
Title

The effectiveness of brain metastases radiotherapy in patients with melanoma

Journal

Nowotwory. Journal of Oncology

Issue

Vol 66, No 5 (2016)

Pages

367-374

Published online

2017-03-29

DOI

10.5603/NJO.2016.0066

Bibliographic record

Nowotwory. Journal of Oncology 2016;66(5):367-374.

Keywords

melanoma
brain metastases
prognostic index

Authors

Bogumiła Szyszka-Charewicz

References (47)
  1. Davies MA, Liu P, McIntyre S, et al. Prognostic factors for survival in melanoma patients with brain metastases. Cancer. 2011; 117(8): 1687–1696.
  2. Carlino MS, Fogarty GB, Long GV. Treatment of melanoma brain metastases: a new paradigm. Cancer J. 2012; 18(2): 208–212.
  3. Majer M, Samlowski WE. Management of metastatic melanoma patients with brain metastases. Curr Oncol Rep. 2007; 9(5): 411–416.
  4. Durando X, Mansard S, Daste A, et al. Stratégies thérapeutiques et traitements systémiques des métastases cérébrales du melanoma. Bull Cancer. 2013; 100: 23–28.
  5. 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.
  6. Harrison BE, Johnson JL, Clough RW, et al. Selection of patients with melanoma brain metastases for aggressive treatment. Am J Clin Oncol. 2003; 26(4): 354–357.
  7. Gaudy-Marqueste C, Regis JM, Muracciole X, et al. Gamma-Knife radiosurgery in the management of melanoma patients with brain metastases: a series of 106 patients without whole-brain radiotherapy. Int J Radiat Oncol Biol Phys. 2006; 65(3): 809–816.
  8. 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.
  9. Samlowski WE, Watson GA, Wang M, et al. Multimodality treatment of melanoma brain metastases incorporating stereotactic radiosurgery (SRS). Cancer. 2007; 109(9): 1855–1862.
  10. Bafaloukos D, Gogas H. The treatment of brain metastases in melanoma patients. Cancer Treat Rev. 2004; 30(6): 515–520.
  11. Powell S, Dudek AZ. Single-institution outcome of high-dose interleukin-2 (HD IL-2) therapy for metastatic melanoma and analysis of favorable response in brain metastases. Anticancer Res. 2009; 29(10): 4189–4193.
  12. Rhun ÉLe, Mateus C, Mortier L, et al. Traitement systémique des métastases cérébrales de mélanome. Cancer/Radiothérapie. 2015; 19(1): 48–54.
  13. Buchsbaum JC, Suh JH, Lee SY, et al. Survival by radiation therapy oncology group recursive partitioning analysis class and treatment modality in patients with brain metastases from malignant melanoma: a retrospective study. Cancer. 2002; 94(8): 2265–2272.
  14. Marcus DM, Lowe M, Khan MK, et al. Prognostic factors for overall survival after radiosurgery for brain metastases from melanoma. Am J Clin Oncol. 2014; 37(6): 580–584.
  15. Hauswald H, Dittmar JO, Habermehl D, et al. Efficacy and toxicity of whole brain radiotherapy in patients with multiple cerebral metastases from malignant melanoma. Radiat Oncol. 2012; 7: 130.
  16. Partl R, Richtig E, Avian A, et al. Karnofsky performance status and lactate dehydrogenase predict the benefit of palliative whole-brain irradiation in patients with advanced intra- and extracranial metastases from malignant melanoma. Int J Radiat Oncol Biol Phys. 2013; 85(3): 662–666.
  17. Mathieu D, Kondziolka D, Cooper PB, et al. Gamma knife radiosurgery in the management of malignant melanoma brain metastases. Neurosurgery. 2007; 60(3): 471–481.
  18. Grob JJ, Regis J, Laurans R, et al. Radiosurgery without whole brain radiotherapy in melanoma brain metastases. Club de Cancérologie Cutanée. Eur J Cancer. 1998; 34(8): 1187–1192.
  19. Manon R, O'Neill A, Knisely J, et al. Eastern Cooperative Oncology Group. Phase II trial of radiosurgery for one to three newly diagnosed brain metastases from renal cell carcinoma, melanoma, and sarcoma: an Eastern Cooperative Oncology Group study (E 6397). J Clin Oncol. 2005; 23(34): 8870–8876.
  20. Radbill AE, Fiveash JF, Falkenberg ET, et al. Initial treatment of melanoma brain metastases using gamma knife radiosurgery: an evaluation of efficacy and toxicity. Cancer. 2004; 101(4): 825–833.
  21. Rate WR, Solin LJ, Turrisi AT. Palliative radiotherapy for metastatic malignant melanoma: brain metastases, bone metastases, and spinal cord compression. Int J Radiat Oncol Biol Phys. 1988; 15(4): 859–864.
  22. Wroński M, Arbit E. Surgical treatment of brain metastases from melanoma: a retrospective study of 91 patients. J Neurosurg. 2000; 93(1): 9–18.
  23. Margolin K, Ernstoff MS, Hamid O, et al. Ipilimumab in patients with melanoma and brain metastases: an open-label, phase 2 trial. Lancet Oncol. 2012; 13(5): 459–465.
  24. Long GV, Trefzer U, Davies MA, et al. Dabrafenib in patients with Val600Glu or Val600Lys BRAF-mutant melanoma metastatic to the brain (BREAK-MB): a multicentre, open-label, phase 2 trial. Lancet Oncol. 2012; 13(11): 1087–1095.
  25. Dummer R, Goldinger SM, Turtschi CP, et al. Vemurafenib in patients with BRAF(V600) mutation-positive melanoma with symptomatic brain metastases: final results of an open-label pilot study. Eur J Cancer. 2014; 50(3): 611–621.
  26. Mathew M, Tam M, Ott PA, et al. Ipilimumab in melanoma with limited brain metastases treated with stereotactic radiosurgery. Melanoma Res. 2013; 23(3): 191–195.
  27. Dzienis MR, Atkinson VG. Response rate to vemurafenib in patients with B-RAF-positive melanoma brain metastases: a retrospective review. Melanoma Res. 2014; 24(4): 349–353.
  28. Konstadoulakis MM, Messaris E, Zografos G, et al. Prognostic factors in malignant melanoma patients with solitary or multiple brain metastases. Is there a role for surgery? J Neurosurg Sci. 2000; 44(4): 211–219.
  29. Devito N, Yu M, Chen R, et al. Retrospective study of patients with brain metastases from melanoma receiving concurrent whole-brain radiation and temozolomide. Anticancer Res. 2011; 31(12): 4537–4543.
  30. Gaspar L, Scott C, Rotman M, et al. Recursive partitioning analysis (RPA) of prognostic factors in three Radiation Therapy Oncology Group (RTOG) brain metastases trials. Int J Radiat Oncol Biol Phys. 1997; 37(4): 745–751.
  31. Lagerwaard FJ, Levendag PC, Nowak PJ, et al. Identification of prognostic factors in patients with brain metastases: a review of 1292 patients. Int J Radiat Oncol Biol Phys. 1999; 43(4): 795–803.
  32. Weltman E, Salvajoli JV, Brandt RA, et al. Radiosurgery for brain metastases: a score index for predicting prognosis. Int J Radiat Oncol Biol Phys. 2000; 46(5): 1155–1161.
  33. Lorenzoni J, Devriendt D, Massager N, et al. Radiosurgery for treatment of brain metastases: estimation of patient eligibility using three stratification systems. Int J Radiat Oncol Biol Phys. 2004; 60(1): 218–224.
  34. Rades D, Dunst J, Schild SE. A new scoring system to predicting the survival of patients treated with whole-brain radiotherapy for brain metastases. Strahlenther Onkol. 2008; 184(5): 251–255.
  35. Sperduto PW, Berkey B, Gaspar LE, et al. A new prognostic index and comparison to three other indices for patients with brain metastases: an analysis of 1,960 patients in the RTOG database. Int J Radiat Oncol Biol Phys. 2008; 70(2): 510–514.
  36. Sperduto PW, Chao ST, Sneed PK, et al. Diagnosis-specific prognostic factors, indexes, and treatment outcomes for patients with newly diagnosed brain metastases: a multi-institutional analysis of 4,259 patients. Int J Radiat Oncol Biol Phys. 2010; 77(3): 655–661.
  37. Nieder C, Marienhagen K, Geinitz H, et 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.
  38. Nieder C, Mehta MP. Prognostic indices for brain metastases--usefulness and challenges. Radiat Oncol. 2009; 4: 10.
  39. 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.
  40. 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.
  41. Zakrzewski J, Geraghty LN, Rose AE, et al. Clinical variables and primary tumor characteristics predictive of the development of melanoma brain metastases and post-brain metastases survival. Cancer. 2011; 117(8): 1711–1720.
  42. 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.
  43. Meier S, Baumert BG, Maier T, et al. Survival and prognostic factors in patients with brain metastases from malignant melanoma. Onkologie. 2004; 27(2): 145–149.
  44. 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.
  45. Zukauskaite R, Schmidt H, Asmussen JT, et al. Asymptomatic brain metastases in patients with cutaneous metastatic malignant melanoma. Melanoma Res. 2013; 23(1): 21–26.
  46. Mathieu D, Kondziolka D, Cooper PB, et al. Gamma knife radiosurgery in the management of malignant melanoma brain metastases. Neurosurgery. 2007; 60(3): 471–481.
  47. Le Scodan R, Massard C, Noël G. Facteurs pronostiques des métastases cérébrales. Bull Cancer. 2013; 100: 45–50.

Important: This website uses cookies. More >>

The cookies allow us to identify your computer and find out details about your last visit. They remembering whether you've visited the site before, so that you remain logged in - or to help us work out how many new website visitors we get each month. Most internet browsers accept cookies automatically, but you can change the settings of your browser to erase cookies or prevent automatic acceptance if you prefer.

Wydawcą serwisu jest VM Media sp. z o.o. VM Group sp.k., ul. Świętokrzyska 73, 80–180 Gdańsk

tel.:+48 58 320 94 94, faks:+48 58 320 94 60, e-mail: viamedica@viamedica.pl