Stereotactic radiosurgery for brain metastases from malignant melanoma and the impact of hemorrhagic metastases. 2018

Kristine Bauer-Nilsen, and Daniel M Trifiletti, and Ajay Chatrath, and Henry Ruiz-Garcia, and Eduardo Marchan, and Jennifer Peterson, and Byron C May, and Jason P Sheehan
Department of Radiation Oncology, University of Virginia, Charlottesville, VA, USA.

BACKGROUND Stereotactic radiosurgery (SRS) is a common treatment modality among patients with brain metastases, particularly from malignant melanoma. Our objective was to investigate the difference in local control, toxicity, and survival among patients with hemorrhagic and solid melanoma brain metastases. METHODS We collected demographic, treatment, local control, toxicity, and survival for 134 patients with a total of 936 intracranial melanoma metastases who underwent SRS between 1998 and 2015. Pre-radiosurgical diagnostic imaging was reviewed for evidence of hemorrhage (melanin-containing or clearly hemorrhagic). RESULTS The cohort consisted of 92 men and 42 women with a mea age of 61.7 years (range 21.2-84.9) at the time of radiosurgery. Overall survival of patients with brain metastases from malignant melanoma was 42, 31, 12% at 12, 24, and 72 months from date of first SRS. At 6 months, 43% of the patients with hemorrhagic metastases had local tumor control compared to 83% of solid melanoma metastases (p < 0.001). No significant difference in toxicity was noted between the two groups. Factors that were significantly associated with time to local tumor progression on multivariate analysis include prior WBRT (HR 1.62, p = 0.003), prior chemotherapy (HR 0.69, p = 0.011), margin dose (HR 0.88, p < 0.001) and radiographic features of melanin deposition (HR 3.73, p < 0.001), or clear hemorrhage (HR 2.20, p < 0.001). CONCLUSIONS Our findings demonstrate that hemorrhagic intracranial melanoma metastases are associated with inferior local tumor control when treated with SRS, as compared to solid tumors. These results highlight the importance of early radiosurgery among patients with melanoma brain metastases before hemorrhage occurs.

UI MeSH Term Description Entries
D008279 Magnetic Resonance Imaging Non-invasive method of demonstrating internal anatomy based on the principle that atomic nuclei in a strong magnetic field absorb pulses of radiofrequency energy and emit them as radiowaves which can be reconstructed into computerized images. The concept includes proton spin tomographic techniques. Chemical Shift Imaging,MR Tomography,MRI Scans,MRI, Functional,Magnetic Resonance Image,Magnetic Resonance Imaging, Functional,Magnetization Transfer Contrast Imaging,NMR Imaging,NMR Tomography,Tomography, NMR,Tomography, Proton Spin,fMRI,Functional Magnetic Resonance Imaging,Imaging, Chemical Shift,Proton Spin Tomography,Spin Echo Imaging,Steady-State Free Precession MRI,Tomography, MR,Zeugmatography,Chemical Shift Imagings,Echo Imaging, Spin,Echo Imagings, Spin,Functional MRI,Functional MRIs,Image, Magnetic Resonance,Imaging, Magnetic Resonance,Imaging, NMR,Imaging, Spin Echo,Imagings, Chemical Shift,Imagings, Spin Echo,MRI Scan,MRIs, Functional,Magnetic Resonance Images,Resonance Image, Magnetic,Scan, MRI,Scans, MRI,Shift Imaging, Chemical,Shift Imagings, Chemical,Spin Echo Imagings,Steady State Free Precession MRI
D008297 Male Males
D008545 Melanoma A malignant neoplasm derived from cells that are capable of forming melanin, which may occur in the skin of any part of the body, in the eye, or, rarely, in the mucous membranes of the genitalia, anus, oral cavity, or other sites. It occurs mostly in adults and may originate de novo or from a pigmented nevus or malignant lentigo. Melanomas frequently metastasize widely, and the regional lymph nodes, liver, lungs, and brain are likely to be involved. The incidence of malignant skin melanomas is rising rapidly in all parts of the world. (Stedman, 25th ed; from Rook et al., Textbook of Dermatology, 4th ed, p2445) Malignant Melanoma,Malignant Melanomas,Melanoma, Malignant,Melanomas,Melanomas, Malignant
D008875 Middle Aged An adult aged 45 - 64 years. Middle Age
D001932 Brain Neoplasms Neoplasms of the intracranial components of the central nervous system, including the cerebral hemispheres, basal ganglia, hypothalamus, thalamus, brain stem, and cerebellum. Brain neoplasms are subdivided into primary (originating from brain tissue) and secondary (i.e., metastatic) forms. Primary neoplasms are subdivided into benign and malignant forms. In general, brain tumors may also be classified by age of onset, histologic type, or presenting location in the brain. Brain Cancer,Brain Metastases,Brain Tumors,Cancer of Brain,Malignant Primary Brain Tumors,Neoplasms, Intracranial,Benign Neoplasms, Brain,Brain Neoplasm, Primary,Brain Neoplasms, Benign,Brain Neoplasms, Malignant,Brain Neoplasms, Malignant, Primary,Brain Neoplasms, Primary Malignant,Brain Tumor, Primary,Brain Tumor, Recurrent,Cancer of the Brain,Intracranial Neoplasms,Malignant Neoplasms, Brain,Malignant Primary Brain Neoplasms,Neoplasms, Brain,Neoplasms, Brain, Benign,Neoplasms, Brain, Malignant,Neoplasms, Brain, Primary,Primary Brain Neoplasms,Primary Malignant Brain Neoplasms,Primary Malignant Brain Tumors,Benign Brain Neoplasm,Benign Brain Neoplasms,Benign Neoplasm, Brain,Brain Benign Neoplasm,Brain Benign Neoplasms,Brain Cancers,Brain Malignant Neoplasm,Brain Malignant Neoplasms,Brain Metastase,Brain Neoplasm,Brain Neoplasm, Benign,Brain Neoplasm, Malignant,Brain Neoplasms, Primary,Brain Tumor,Brain Tumors, Recurrent,Cancer, Brain,Intracranial Neoplasm,Malignant Brain Neoplasm,Malignant Brain Neoplasms,Malignant Neoplasm, Brain,Neoplasm, Brain,Neoplasm, Intracranial,Primary Brain Neoplasm,Primary Brain Tumor,Primary Brain Tumors,Recurrent Brain Tumor,Recurrent Brain Tumors,Tumor, Brain
D005260 Female Females
D006801 Humans Members of the species Homo sapiens. Homo sapiens,Man (Taxonomy),Human,Man, Modern,Modern Man
D000328 Adult A person having attained full growth or maturity. Adults are of 19 through 44 years of age. For a person between 19 and 24 years of age, YOUNG ADULT is available. Adults
D000368 Aged A person 65 years of age or older. For a person older than 79 years, AGED, 80 AND OVER is available. Elderly
D000369 Aged, 80 and over Persons 80 years of age and older. Oldest Old

Related Publications

Kristine Bauer-Nilsen, and Daniel M Trifiletti, and Ajay Chatrath, and Henry Ruiz-Garcia, and Eduardo Marchan, and Jennifer Peterson, and Byron C May, and Jason P Sheehan
January 2015, Surgical neurology international,
Kristine Bauer-Nilsen, and Daniel M Trifiletti, and Ajay Chatrath, and Henry Ruiz-Garcia, and Eduardo Marchan, and Jennifer Peterson, and Byron C May, and Jason P Sheehan
July 2015, BMC cancer,
Kristine Bauer-Nilsen, and Daniel M Trifiletti, and Ajay Chatrath, and Henry Ruiz-Garcia, and Eduardo Marchan, and Jennifer Peterson, and Byron C May, and Jason P Sheehan
December 1996, The Surgical clinics of North America,
Kristine Bauer-Nilsen, and Daniel M Trifiletti, and Ajay Chatrath, and Henry Ruiz-Garcia, and Eduardo Marchan, and Jennifer Peterson, and Byron C May, and Jason P Sheehan
July 2017, Cureus,
Kristine Bauer-Nilsen, and Daniel M Trifiletti, and Ajay Chatrath, and Henry Ruiz-Garcia, and Eduardo Marchan, and Jennifer Peterson, and Byron C May, and Jason P Sheehan
October 2017, American journal of clinical oncology,
Kristine Bauer-Nilsen, and Daniel M Trifiletti, and Ajay Chatrath, and Henry Ruiz-Garcia, and Eduardo Marchan, and Jennifer Peterson, and Byron C May, and Jason P Sheehan
January 1998, The cancer journal from Scientific American,
Kristine Bauer-Nilsen, and Daniel M Trifiletti, and Ajay Chatrath, and Henry Ruiz-Garcia, and Eduardo Marchan, and Jennifer Peterson, and Byron C May, and Jason P Sheehan
January 2012, Journal of cancer research and therapeutics,
Kristine Bauer-Nilsen, and Daniel M Trifiletti, and Ajay Chatrath, and Henry Ruiz-Garcia, and Eduardo Marchan, and Jennifer Peterson, and Byron C May, and Jason P Sheehan
January 1998, The cancer journal from Scientific American,
Kristine Bauer-Nilsen, and Daniel M Trifiletti, and Ajay Chatrath, and Henry Ruiz-Garcia, and Eduardo Marchan, and Jennifer Peterson, and Byron C May, and Jason P Sheehan
January 2007, Clinical neurosurgery,
Kristine Bauer-Nilsen, and Daniel M Trifiletti, and Ajay Chatrath, and Henry Ruiz-Garcia, and Eduardo Marchan, and Jennifer Peterson, and Byron C May, and Jason P Sheehan
October 2013, Neurosurgery clinics of North America,
Copied contents to your clipboard!