Brain metastasis from melanoma: the prognostic value of varying sites of extracranial disease

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• 作者：James E. Bates ; Paul Youn ; Kenneth Y. Usuki ; Kevin A. Walter…
• 关键词：Radiosurgery ; Melanoma ; Brain metastasis ; Limited metastasis ; SRS ; Oligometastasis
• 刊名：Journal of Neuro-Oncology
• 出版年：2015
• 出版时间：November 2015
• 年：2015
• 卷：125
• 期：2
• 页码：411-418
• 全文大小：427 KB
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• 作者单位：James E. Bates (1)
  Paul Youn (1)
  Kenneth Y. Usuki (1)
  Kevin A. Walter (2)
  Christine F. Huggins (1)
  Paul Okunieff (3)
  Michael T. Milano (1)
  
  1. Department of Radiation Oncology, University of Rochester Medical Center, 601 Elmwood Avenue, Rochester, NY, 14642, USA
  2. Department of Neurosurgery, University of Rochester Medical Center, 601 Elmwood Avenue, Rochester, NY, 14642, USA
  3. Department of Radiation Oncology, College of Medicine, University of Florida, 2000 SW Archer Road, Gainesville, FL, 32610, USA
  
• 刊物类别：Medicine
• 刊物主题：Medicine & Public Health
  Oncology
  
• 出版者：Springer Netherlands
• ISSN：1573-7373

文摘

Patients with brain metastasis from melanoma have poor outcomes. Radiation is used both for prognostic and symptomatic value. We aimed to further clarify the role of stereotactic radiosurgery (SRS) and whole brain radiotherapy (WBRT) as well as the prognostic implication of various sites of extracranial disease. The records of 73 consecutive patients treated at the University of Rochester Medical Center for brain-metastatic melanoma from January 2004 to October 2013 were reviewed. The median overall survival (OS) was 3.0 months. Patients treated with WBRT alone had decreased OS compared to those treated with SRS alone (HR = 0.38, p = 0.001) or WBRT and SRS (HR = 0.51, p = 0.039). The mean number of brain metastasis differed (p = 0.002) in patients in patients who received WBRT (4.0) compared to those who did not (2.0). Among patients with extracranial disease (n = 63), bone metastasis (HR = 1.86, p = 0.047, n = 15) was a negative prognostic factor; liver (HR = 1.59, p = 0.113, n = 17), lung (HR = 1.51, p = 0.23, n = 51) and adrenal metastasis (HR = 1.70, p = 0.15, n = 10) were not. In patients with concurrent brain and lung metastasis, those with disease limited to those two sites (OS = 8.7 mo, n = 13) had improved OS (HR = 0.44, p = 0.014) compared to those with additional disease (OS = 1.8 mo, n = 50). Based on this hypothesis-generating retrospective analysis, SRS may offer survival benefit compared to WBRT alone in patients with brain metastatic melanoma. Bone metastasis appears to confer a particularly poor prognosis. Those with disease confined to the lung and brain may represent a population with improved prognosis.