Neoplasma Vol.52, p.150-158, 2005
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Title: Cerebral metastases of malignant melanoma: contemporary treatment
modalities and survival outcome
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Author: I.E., PANAGIOTOU
; E.N., BROUNTZOS
; D.A., KELEKIS
; M.A., PAPATHANASIOU
; D.I., BAFALOUKOS
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Abstract: The aim of our study was to analyze prognostic factors, effect of
treatment and survival outcome of a contemporary cohort of
melanoma patients with cerebral metastases and eventually propose
new recommendations regarding therapy.
Sixty four patients with melanoma brain metastases were treated in
our department within a 15-year period. We performed a
retrospective analysis of their survival with respect to the type
of treatment instituted. Four groups were formed according to
treatment: Group A patients treated with surgery followed by
radiotherapy; group B temozolomide as first-line treatment and
radiotherapy after cerebral disease progression; group C
radiotherapy alone; group D supportive care only.
Patients’ characteristics influenced the selection of treatment
modality: Group A (7.8 %) patients with a single brain metastasis
(p=0.001) and controlled extra-cranial disease (p<0.0001), while
Group D (21.8 %) patients with ulcerated primary lesions (p=0.010)
and uncontrolled extra-cranial disease (p<0.0001). Only group B
(26.6 %) and C (43.7 %) patients with similar characteristics
including more than one brain lesion. Median overall survival was
3 months. In univariate analysis, median survival for groups A, B,
C and D was 12, 5, 3 and 2 months, respectively (p<0.0001). The
survival difference between the surgery and non-surgery groups was
statistically significant (p=0.0011). Patients treated with
supportive care had the worse prognosis (p<0.0001). A survival
benefit for patients receiving first-line treatment with
temozolomide, as compared to those receiving radiotherapy alone
was noted (p=0.0267). In multivariate survival analysis, the
number of brain lesions (p=0.0138), the absence of uncontrolled
extra-cranial disease (p=0.00221) and the type of treatment for
the cerebral disease (p=0.0053) remained significant independent
survival predictors.
Patients’ characteristics remain a critical factor for treatment
selection. The number of brain metastases, the extent of disease
and the type of treatment represent independent survival
predictors. Melanoma patients with a single brain metastasis and
controlled extra-cranial disease gain a survival benefit, if
surgically treated. Including temozolomide in the first-line
treatment of melanoma patients with brain metastases who would
have been treated with radiotherapy alone, might present a
promising future direction affecting the length of survival.
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Keywords: melanoma, brain metastases, survival, treatment, temozolomide
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Year: 2005, Volume: 52, Issue: |
Page From: 150, Page To: 158 |
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