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Initial treatment of melanoma brain metastases using gamma
knife radiosurgery: an evaluation of efficacy and toxicity
Radbill AE, Fiveash JF, Falkenberg ET, Guthrie BL, Young PE, Meleth S,
Markert JM
Department of Medicine, Children's Hospital, Boston, Massachusetts, USA.
Background. Melanoma is the primary malignancy that is most likely to
metastasize to the brain.
Because such an event carries an almost uniformly poor
prognosis, the current study reviewed outcomes and identified associated
prognostic indicators for 51 consecutive patients receiving gamma knife (GK)
radiosurgery in the initial treatment of 188 intracranial melanoma metastases.
Medthods. Data were collected retrospectively from a single-center GK
radiosurgery database and from primary patient medical records and radiographs.
Results. At presentation, 71% of patients had multiple intracranial metastases,
and extracranial metastases were present in 66% of patients.
Thirty-two patients
(63%) were initially treated with GK radiosurgery alone, whereas the remainder
received GK radiosurgery in combination with surgery and/or whole-brain
radiotherapy (WBRT).
Overall median survival from time of GK radiosurgery was 26
weeks.
Subgroup analysis revealed a median survival of 77 weeks for patients
presenting with a single lesion, compared with 20 weeks for patients presenting
with multiple lesions (P = 0.003).
Patients in recursive partitioning analysis
(RPA) Class I survived a median of 57 weeks, compared with a median survival of
20 weeks for patients in RPA Class II or III (P = 0.002).
Although long-term
imaging follow-up revealed that a majority of patients experienced distant brain
metastases, multivariate analysis showed that distant metastases occurred
significantly sooner in patients with extracranial metastases (P = 0.0004).
Addition of initial WBRT had no significant effect on the time to development of
new brain metastases (P = 0.13).
Local control (crude) was observed in 81% of
lesions initially treated with GK.
Patients experienced improved or stable
symptoms for a median of 37 weeks post-GK radiosurgery.
Conclusions. Survival
analyses supported the use of GK radiosurgery in the initial treatment of
patients with melanoma brain metastases, with best results occurring in patients
presenting with a single lesion.
Copyright 2004 American Cancer Society.
PMID: 15305416 [PubMed - in process]
Source: http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=Abstract&list_uids=15305416
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