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Determinants
of outcome in melanoma patients with cerebral metastases
Fife KM, Colman MH, Stevens GN, Firth IC, Moon D, Shannon KF, Harman R,
Petersen-Schaefer K, Zacest AC, Besser M, Milton GW, McCarthy WH, Thompson JF
Department of Radiation Oncology and Neurology, Royal Prince
Alfred Hospital, University of Sydney, Sydney, New South Wales, Australia.
Purpose. To analyze prognostic factors, effects of treatment, and
survival for patients with cerebral metastases from melanoma.
Patients
and Methods. All
melanoma patients with cerebral metastases treated at the Sydney Melanoma Unit
between 1952 and 2000 were identified.
From 1985 to 2000, patients were diagnosed and treated using consistent modern
techniques and this cohort was analyzed in detail.
Multivariate analysis of prognostic factors for survival was performed.
Results.
A total of 1137 patients with cerebral metastases were identified; 686 were
treated between 1985 and 2000.
For these 686 patients, the median time from
primary diagnosis to cerebral metastasis was 3.1 years (range, 0 to 41 years).
A
total of 646 patients (94%) have died as a result of melanoma.
The median
survival from the time of diagnosis of cerebral metastasis was 4.1 months
(range, 0 to 17.2 years).
Treatment was as follows: surgery and postoperative
radiotherapy, 158 patients; surgery alone, 47 patients; radiotherapy alone, 236
patients; and supportive care alone, 210 patients.
Median survival according to
treatment received for these four groups was 8.9, 8.7, 3.4, and 2.1 months,
respectively; the differences between surgery and nonsurgery groups were
statistically significant.
On multivariate analysis, significant factors
associated with improved survival were surgical treatment (P <.0001), no
concurrent extracerebral metastases (P <.0001), younger age (P =.0007), and
longer disease-free interval (P =.036).
Prognostic factors analysis confirmed
the important influence of patient selection on treatment received.
Conclusion.
This large series documents the characteristics of patients who developed
cerebral metastases from melanoma.
Median survival was dependent on treatment,
which in turn was dependent on patient selection.
PMID: 15051777 [PubMed - indexed for MEDLINE]
Source:
http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=Abstract&list_uids=15051777
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