Local control of melanoma brain metastases treated with stereotactic radiosurgery
Hilary P. Bagshaw, David Ly, Gita Suneja, Randy L. Jensen and Dennis C. Shrieve
Purpose: To examine the effectiveness of stereotactic radiosurgery (SRS) for melanoma brain metastases, as the optimal management is unknown.
Materials and Methods: Patients with melanoma brain metastases treated between 1999 and 2013 with SRS as initial management were reviewed. Local control (LC), intracranial progression free survival, and overall survival were evaluated using the Kaplan Meier analysis and logistic regression.
Results: 185 patients were identified with 435 treated brain metastases. 76% of metastases were controlled, with a median freedom from local failure of 23.4 months. Higher SRS dose (p=0.001) and smaller tumor volume (p=0.0007) were associated with improved LC on univariate analysis, but on multivariate analysis only smaller tumor volume remained significant (p=0.047). At analysis, 7.6% of patients were alive and the median time to death after SRS was 7.8 months.
Conclusions: SRS is an effective primary treatment for melanoma brain metastases. There was no benefit combining SRS and surgery or whole brain radiotherapy.
Keywords: melanoma, radiosurgery, brain metastases, whole brain radiotherapy, operative bed, stereotactic.