Outcome predictors of Gamma Knife surgery for melanoma brain metastases: Clinical article

To evaluate the role of stereotactic radiosurgery (SRS) in the management of brain metastases from melanoma, the authors assessed clinical outcomes and prognostic factors for survival and tumor control. The authors reviewed 333 consecutive patients with melanoma who underwent SRS for 1570 brain meta...

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Veröffentlicht in:Journal of neurosurgery 2011-03, Vol.114 (3), p.769-779
Hauptverfasser: LIEW, Donald N, KANO, Hideyuki, KONDZIOLKA, Douglas, MATHIEU, David, NIRANJAN, Ajay, FLICKINGER, John C, KIRKWOOD, John M, TARHINI, Ahmad, MOSCHOS, Stergios, LUNSFORD, L. Dade
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container_issue 3
container_start_page 769
container_title Journal of neurosurgery
container_volume 114
creator LIEW, Donald N
KANO, Hideyuki
KONDZIOLKA, Douglas
MATHIEU, David
NIRANJAN, Ajay
FLICKINGER, John C
KIRKWOOD, John M
TARHINI, Ahmad
MOSCHOS, Stergios
LUNSFORD, L. Dade
description To evaluate the role of stereotactic radiosurgery (SRS) in the management of brain metastases from melanoma, the authors assessed clinical outcomes and prognostic factors for survival and tumor control. The authors reviewed 333 consecutive patients with melanoma who underwent SRS for 1570 brain metastases from cutaneous and mucosal/acral melanoma. The patient population consisted of 109 female and 224 male patients with a median age of 53 years. Two hundred eleven patients (63%) had multiple metastases. One hundred eighteen patients (35%) underwent whole-brain radiation therapy (WBRT). The target volume ranged from 0.1 cm(3) to 37.2 cm(3). The median marginal dose was 18 Gy. Actuarial survival rates were 70% at 3 months, 47% at 6 months, 25% at 12 months, and 10% at 24 months after radiosurgery. Factors associated with longer survival included controlled extracranial disease, better Karnofsky Performance Scale score, fewer brain metastases, no prior WBRT, no prior chemotherapy, administration of immunotherapy, and no intratumoral hemorrhage before radiosurgery. The median survival for patients with a solitary brain metastasis, controlled extracranial disease, and administration of immunotherapy after radiosurgery was 22 months. Sustained local tumor control was achieved in 73% of the patients. Sixty-four (25%) of 259 patients who had follow-up imaging after SRS had evidence of delayed intratumoral hemorrhage. Sixteen patients underwent a craniotomy due to intratumoral hemorrhage. Seventeen patients (6%) had asymptomatic and 21 patients (7%) had symptomatic radiation effects. Patients with ≤ 8 brain metastases, no prior WBRT, and the recursive partitioning analysis Class I had extended survivals (median 54.3 months). Stereotactic radiosurgery is an especially valuable option for patients with controlled systemic disease even if they have multiple metastatic brain tumors.
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Seventeen patients (6%) had asymptomatic and 21 patients (7%) had symptomatic radiation effects. Patients with ≤ 8 brain metastases, no prior WBRT, and the recursive partitioning analysis Class I had extended survivals (median 54.3 months). Stereotactic radiosurgery is an especially valuable option for patients with controlled systemic disease even if they have multiple metastatic brain tumors.</abstract><cop>Charlottesville, VA</cop><pub>American Association of Neurological Surgeons</pub><pmid>20524829</pmid><doi>10.3171/2010.5.JNS1014</doi><tpages>11</tpages></addata></record>
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subjects Adolescent
Adult
Aged
Aged, 80 and over
Biological and medical sciences
Brain Neoplasms - secondary
Brain Neoplasms - surgery
Craniotomy
Female
Follow-Up Studies
Humans
Kaplan-Meier Estimate
Karnofsky Performance Status
Male
Medical sciences
Melanoma - secondary
Melanoma - surgery
Middle Aged
Neurosurgery
Prognosis
Radiosurgery
Retrospective Studies
Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases
Survival Analysis
Treatment Outcome
Young Adult
title Outcome predictors of Gamma Knife surgery for melanoma brain metastases: Clinical article
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