Multimodality treatment of melanoma brain metastases incorporating stereotactic radiosurgery (SRS)

Wolfram E. Samlowski, Gordon A. Watson, Michael Wang, Ganesh Rao, Paul Klimo, Kenneth Boucher, Dennis C. Shrieve, Randy L. Jensen

Research output: Contribution to journalArticle

62 Citations (Scopus)

Abstract

BACKGROUND. Brain metastases are a frequent complication in advanced melanoma. A 3.6 to 4.1-month median survival has been reported after treatment with whole brain radiotherapy. We performed a retrospective analysis of our institutional experience of multimodality treatment utilizing linear accelerator (Linac)-based stereotactic radiosurgery (SRS). METHODS. Forty-four melanoma patients with brain metastases underwent 66 SRS treatments for 156 metastatic foci between 1999 and 2004. Patients were treated with initial SRS if ≤5 brain metastases were present. All patients had Karnofsky Performance Status (KPS) ≥70, but 37 patients had active systemic metastases (Recursive Partition Analysis Class 2). Survival was calculated from the time of diagnosis of brain metastases. Minimum follow-up was 1 year after SRS. The potential role of prognostic factors on survival was evaluated including age, sex, interval from initial diagnosis to brain metastases, surgical resection, addition of whole brain radiotherapy (WBRT), number of initial metastases treated, and number of SRS treatments using Cox univariate analysis. RESULTS. The median survival of melanoma patients with brain metastases was 11.1 months (95% confidence interval [CI]: 8.2-14.9 months) from diagnosis. One-year and 2-year survivals were 47.7% and 17.7%, respectively. There was no apparent effect of age or sex. Surgery or multiple stereotactic radiotherapy treatments were associated with prolonged survival. Addition of WBRT to maintain control of brain metastases in a subset of patients did not improve survival. CONCLUSIONS. Our results suggest that aggressive treatment of patients with up to 5 melanoma brain metastases including SRS appears to prolong survival. Subsequent chemotherapy or immunotherapy after SRS may have contributed to the observed outcome.

Original languageEnglish (US)
Pages (from-to)1855-1862
Number of pages8
JournalCancer
Volume109
Issue number9
DOIs
StatePublished - May 1 2007
Externally publishedYes

Fingerprint

Radiosurgery
Melanoma
Neoplasm Metastasis
Brain
Survival
Radiotherapy
Therapeutics
Karnofsky Performance Status
Particle Accelerators
Immunotherapy
Confidence Intervals
Drug Therapy

All Science Journal Classification (ASJC) codes

  • Oncology
  • Cancer Research

Cite this

Samlowski, W. E., Watson, G. A., Wang, M., Rao, G., Klimo, P., Boucher, K., ... Jensen, R. L. (2007). Multimodality treatment of melanoma brain metastases incorporating stereotactic radiosurgery (SRS). Cancer, 109(9), 1855-1862. https://doi.org/10.1002/cncr.22605

Multimodality treatment of melanoma brain metastases incorporating stereotactic radiosurgery (SRS). / Samlowski, Wolfram E.; Watson, Gordon A.; Wang, Michael; Rao, Ganesh; Klimo, Paul; Boucher, Kenneth; Shrieve, Dennis C.; Jensen, Randy L.

In: Cancer, Vol. 109, No. 9, 01.05.2007, p. 1855-1862.

Research output: Contribution to journalArticle

Samlowski, WE, Watson, GA, Wang, M, Rao, G, Klimo, P, Boucher, K, Shrieve, DC & Jensen, RL 2007, 'Multimodality treatment of melanoma brain metastases incorporating stereotactic radiosurgery (SRS)', Cancer, vol. 109, no. 9, pp. 1855-1862. https://doi.org/10.1002/cncr.22605
Samlowski, Wolfram E. ; Watson, Gordon A. ; Wang, Michael ; Rao, Ganesh ; Klimo, Paul ; Boucher, Kenneth ; Shrieve, Dennis C. ; Jensen, Randy L. / Multimodality treatment of melanoma brain metastases incorporating stereotactic radiosurgery (SRS). In: Cancer. 2007 ; Vol. 109, No. 9. pp. 1855-1862.
@article{ce61668b9b204ea39b958fb1eaa3437a,
title = "Multimodality treatment of melanoma brain metastases incorporating stereotactic radiosurgery (SRS)",
abstract = "BACKGROUND. Brain metastases are a frequent complication in advanced melanoma. A 3.6 to 4.1-month median survival has been reported after treatment with whole brain radiotherapy. We performed a retrospective analysis of our institutional experience of multimodality treatment utilizing linear accelerator (Linac)-based stereotactic radiosurgery (SRS). METHODS. Forty-four melanoma patients with brain metastases underwent 66 SRS treatments for 156 metastatic foci between 1999 and 2004. Patients were treated with initial SRS if ≤5 brain metastases were present. All patients had Karnofsky Performance Status (KPS) ≥70, but 37 patients had active systemic metastases (Recursive Partition Analysis Class 2). Survival was calculated from the time of diagnosis of brain metastases. Minimum follow-up was 1 year after SRS. The potential role of prognostic factors on survival was evaluated including age, sex, interval from initial diagnosis to brain metastases, surgical resection, addition of whole brain radiotherapy (WBRT), number of initial metastases treated, and number of SRS treatments using Cox univariate analysis. RESULTS. The median survival of melanoma patients with brain metastases was 11.1 months (95{\%} confidence interval [CI]: 8.2-14.9 months) from diagnosis. One-year and 2-year survivals were 47.7{\%} and 17.7{\%}, respectively. There was no apparent effect of age or sex. Surgery or multiple stereotactic radiotherapy treatments were associated with prolonged survival. Addition of WBRT to maintain control of brain metastases in a subset of patients did not improve survival. CONCLUSIONS. Our results suggest that aggressive treatment of patients with up to 5 melanoma brain metastases including SRS appears to prolong survival. Subsequent chemotherapy or immunotherapy after SRS may have contributed to the observed outcome.",
author = "Samlowski, {Wolfram E.} and Watson, {Gordon A.} and Michael Wang and Ganesh Rao and Paul Klimo and Kenneth Boucher and Shrieve, {Dennis C.} and Jensen, {Randy L.}",
year = "2007",
month = "5",
day = "1",
doi = "10.1002/cncr.22605",
language = "English (US)",
volume = "109",
pages = "1855--1862",
journal = "Cancer",
issn = "0008-543X",
publisher = "John Wiley and Sons Inc.",
number = "9",

}

TY - JOUR

T1 - Multimodality treatment of melanoma brain metastases incorporating stereotactic radiosurgery (SRS)

AU - Samlowski, Wolfram E.

AU - Watson, Gordon A.

AU - Wang, Michael

AU - Rao, Ganesh

AU - Klimo, Paul

AU - Boucher, Kenneth

AU - Shrieve, Dennis C.

AU - Jensen, Randy L.

PY - 2007/5/1

Y1 - 2007/5/1

N2 - BACKGROUND. Brain metastases are a frequent complication in advanced melanoma. A 3.6 to 4.1-month median survival has been reported after treatment with whole brain radiotherapy. We performed a retrospective analysis of our institutional experience of multimodality treatment utilizing linear accelerator (Linac)-based stereotactic radiosurgery (SRS). METHODS. Forty-four melanoma patients with brain metastases underwent 66 SRS treatments for 156 metastatic foci between 1999 and 2004. Patients were treated with initial SRS if ≤5 brain metastases were present. All patients had Karnofsky Performance Status (KPS) ≥70, but 37 patients had active systemic metastases (Recursive Partition Analysis Class 2). Survival was calculated from the time of diagnosis of brain metastases. Minimum follow-up was 1 year after SRS. The potential role of prognostic factors on survival was evaluated including age, sex, interval from initial diagnosis to brain metastases, surgical resection, addition of whole brain radiotherapy (WBRT), number of initial metastases treated, and number of SRS treatments using Cox univariate analysis. RESULTS. The median survival of melanoma patients with brain metastases was 11.1 months (95% confidence interval [CI]: 8.2-14.9 months) from diagnosis. One-year and 2-year survivals were 47.7% and 17.7%, respectively. There was no apparent effect of age or sex. Surgery or multiple stereotactic radiotherapy treatments were associated with prolonged survival. Addition of WBRT to maintain control of brain metastases in a subset of patients did not improve survival. CONCLUSIONS. Our results suggest that aggressive treatment of patients with up to 5 melanoma brain metastases including SRS appears to prolong survival. Subsequent chemotherapy or immunotherapy after SRS may have contributed to the observed outcome.

AB - BACKGROUND. Brain metastases are a frequent complication in advanced melanoma. A 3.6 to 4.1-month median survival has been reported after treatment with whole brain radiotherapy. We performed a retrospective analysis of our institutional experience of multimodality treatment utilizing linear accelerator (Linac)-based stereotactic radiosurgery (SRS). METHODS. Forty-four melanoma patients with brain metastases underwent 66 SRS treatments for 156 metastatic foci between 1999 and 2004. Patients were treated with initial SRS if ≤5 brain metastases were present. All patients had Karnofsky Performance Status (KPS) ≥70, but 37 patients had active systemic metastases (Recursive Partition Analysis Class 2). Survival was calculated from the time of diagnosis of brain metastases. Minimum follow-up was 1 year after SRS. The potential role of prognostic factors on survival was evaluated including age, sex, interval from initial diagnosis to brain metastases, surgical resection, addition of whole brain radiotherapy (WBRT), number of initial metastases treated, and number of SRS treatments using Cox univariate analysis. RESULTS. The median survival of melanoma patients with brain metastases was 11.1 months (95% confidence interval [CI]: 8.2-14.9 months) from diagnosis. One-year and 2-year survivals were 47.7% and 17.7%, respectively. There was no apparent effect of age or sex. Surgery or multiple stereotactic radiotherapy treatments were associated with prolonged survival. Addition of WBRT to maintain control of brain metastases in a subset of patients did not improve survival. CONCLUSIONS. Our results suggest that aggressive treatment of patients with up to 5 melanoma brain metastases including SRS appears to prolong survival. Subsequent chemotherapy or immunotherapy after SRS may have contributed to the observed outcome.

UR - http://www.scopus.com/inward/record.url?scp=34247634463&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=34247634463&partnerID=8YFLogxK

U2 - 10.1002/cncr.22605

DO - 10.1002/cncr.22605

M3 - Article

VL - 109

SP - 1855

EP - 1862

JO - Cancer

JF - Cancer

SN - 0008-543X

IS - 9

ER -