Initial treatment of melanoma brain metastases using gamma knife radiosurgery

Abstract OBJECTIVE Radiosurgery is increasingly used to manage malignant melanoma brain metastases. We reviewed our series of patients who underwent radiosurgery for melanoma brain metastases to assess clinical outcomes and identify prognostic factors for survival and cerebral disease control. METHODS Two hundred forty-four patients had radiosurgery for the management of 754 metastatic tumors. A mean of 2.6 tumors were irradiated per procedure. The median tumor volume was 4.4 cm3. The median margin and maximum doses used were 18 and 32 Gy, respectively. RESULTS The median survival was 5.3 months after radiosurgery (mean, 10 mo; range, 0.2–114.3 mo). Patients survived a median of 7.8 months (mean, 13.4 mo) from the diagnosis of brain metastases and 44.9 months (mean, 69 mo) after the diagnosis of the primary tumor. Survival was better in patients with controlled systemic disease (12.7 mo), single brain metastasis (6.8 mo), and a Karnofsky performance score of 90 or 100% (6.3 mo). Sustained local control was achieved in 86.2% of tumors. Increased tumor volume and previous evidence of hemorrhage increased the risk of local failure. Multiple lesions and failure to provide systemic immunotherapy were predictors for the occurrence of new brain metastases, which developed in 41.7% of the patients. Symptomatic radiation changes occurred in 6.6% of the patients. Overall, 71.4% of the patients improved or remained clinically stable. Brain disease was the cause of death in 40.5% of the patients, usually from the development of new metastases. CONCLUSION Gamma knife radiosurgery for malignant melanoma brain metastases is safe and effective and provides a high rate of durable local control. Improved survival can be achieved in patients with single metastasis, controlled systemic disease, and a high Karnofsky performance score.

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Predictors of Survival, Neurologic Death, Local Failure, and Distant Failure After Gamma Knife Radiosurgery for Melanoma Brain Metastases

World Neurosurgery ◽

10.1016/j.wneu.2013.02.025 ◽

2014 ◽

Vol 82 (6) ◽

pp. 1250-1255 ◽

Cited By ~ 24

Author(s):

Matthew T. Neal ◽

Michael D. Chan ◽

John T. Lucas ◽

Amritraj Loganathan ◽

Christine Dillingham ◽

...

Keyword(s):

Brain Metastases ◽

Gamma Knife ◽

Gamma Knife Radiosurgery ◽

Local Failure ◽

Distant Failure ◽

Melanoma Brain Metastases

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Gamma Knife Radiosurgery for Malignant Melanoma Brain Metastases 907

Neurosurgery ◽

10.1227/01.neu.0000309957.49508.22 ◽

2006 ◽

Keyword(s):

Malignant Melanoma ◽

Brain Metastases ◽

Gamma Knife ◽

Gamma Knife Radiosurgery ◽

Melanoma Brain Metastases

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BRAF Mutation Is Associated with Improved Local Control of Melanoma Brain Metastases Treated with Gamma Knife Radiosurgery

Frontiers in Oncology ◽

10.3389/fonc.2016.00107 ◽

2016 ◽

Vol 6 ◽

Cited By ~ 5

Author(s):

Ian S. Gallaher ◽

Yoichi Watanabe ◽

Todd E. DeFor ◽

Kathryn E. Dusenbery ◽

Chung K. Lee ◽

...

Keyword(s):

Brain Metastases ◽

Gamma Knife ◽

Local Control ◽

Braf Mutation ◽

Gamma Knife Radiosurgery ◽

Melanoma Brain Metastases

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Gamma knife radiosurgery for renal cell carcinoma brain metastases

Journal of Neurosurgery ◽

10.3171/jns.2002.97.supplement_5.0489 ◽

2002 ◽

Vol 97 ◽

pp. 489-493 ◽

Cited By ~ 42

Author(s):

Laura Hernandez ◽

Lucia Zamorano ◽

Andrew Sloan ◽

James Fontanesi ◽

Simon Lo ◽

...

Keyword(s):

Renal Cell Carcinoma ◽

Brain Metastases ◽

Cell Carcinoma ◽

Gamma Knife ◽

Median Survival ◽

Renal Cell ◽

Univariate Analysis ◽

Gamma Knife Radiosurgery ◽

Content Type ◽

Fine Print

Object. The purpose of this study was to clarify the effectiveness of gamma knife radiosurgery (GKS) in achieving a partial or complete remission of so-called radioresistant metastases from renal cell carcinoma (RCC) and to propose guidelines for optimal treatment Methods. During a 5-year period, 29 patients (19 male and 10 female) with 92 brain metastases from RCC underwent GKS. The median tumor volume was 4.7 cm3 (range 0.5–14.5 cm3). Fourteen patients (48%) also underwent whole-brain radiotherapy (WBRT) before GKS, and two patients (6.8%) after GKS. The mean GKS dose delivered to the 50% isodose at the tumor margin was 16.8 Gy (range 13–30 Gy). All cases were categorized according to the Recursive Partitioning Analysis (RPA) classification for brain metastases. Univariate analysis was performed to determine significant prognostic factors and survival. The overall median survival was 7 months after GKS treatment. Age, sex, Karnofsky Performance Scale score, and controlled primary disease were not predictors of survival. Combined WBRT/GKS resulted in median survival of 18, 8.5, and 5.3 months for RPA Classes I, II, and III, respectively, compared with the median survival 7.1, 4.2, and 2.3 months for patients treated with WBRT alone. Conclusions. These results suggest that WBRT combined with GKS may improve survival in patients with brain metastases from RCC. Furthermore, this improvement in survival was seen in all RPA classes.

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Validation of the updated renal graded prognostic assessment (GPA) for patients with renal cancer brain metastases treated with gamma knife radiosurgery

Journal of Neuro-Oncology ◽

10.1007/s11060-021-03793-9 ◽

2021 ◽

Author(s):

Niels J. van Ruitenbeek ◽

Vincent K. Y. Ho ◽

Hans M. Westgeest ◽

Laurens V. Beerepoot ◽

Patrick E. J. Hanssens

Keyword(s):

Brain Metastases ◽

Gamma Knife ◽

Renal Cancer ◽

Gamma Knife Radiosurgery ◽

Prognostic Assessment ◽

Graded Prognostic Assessment

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Ten-Year Survival of a Patient Treated with Stereotactic Gamma Knife Radiosurgery for Brain Metastases from Colon Cancer with Ovarian and Lymph Node Metastases: A Case Report

Case Reports in Gastroenterology ◽

10.1159/000445976 ◽

2016 ◽

Vol 10 (1) ◽

pp. 204-211 ◽

Cited By ~ 2

Author(s):

Nobuhiro Morinaga ◽

Naritaka Tanaka ◽

Yoshinori Shitara ◽

Masatoshi Ishizaki ◽

Takatomo Yoshida ◽

...

Keyword(s):

Colon Cancer ◽

Lymph Node ◽

Brain Metastasis ◽

Brain Metastases ◽

Sigmoid Colon ◽

Gamma Knife ◽

Gamma Knife Radiosurgery ◽

Sigmoid Colon Cancer ◽

Ovarian Lesion ◽

Node Metastases

Brain metastasis from colorectal cancer is infrequent and carries a poor prognosis. Herein, we present a patient alive 10 years after the identification of a first brain metastasis from sigmoid colon cancer. A 39-year-old woman underwent sigmoidectomy for sigmoid colon cancer during an emergency operation for pelvic peritonitis. The pathological finding was moderately differentiated adenocarcinoma. Eleven months after the sigmoidectomy, a metastatic lesion was identified in the left ovary. Despite local radiotherapy followed by chemotherapy, the left ovarian lesion grew, so resection of the uterus and bilateral ovaries was performed. Adjuvant chemotherapy with tegafur-uracil (UFT)/calcium folinate (leucovorin, LV) was initiated. Seven months after resection of the ovarian lesion, brain metastases appeared in the bilateral frontal lobes and were treated with stereotactic Gamma Knife radiosurgery. Cervical and mediastinal lymph node metastases were also diagnosed, and irradiation of these lesions was performed. After radiotherapy, 10 courses of oxaliplatin and infused fluorouracil plus leucovorin (FOLFOX) were administered. During FOLFOX administration, recurrent left frontal lobe brain metastasis was diagnosed and treated with stereotactic Gamma Knife radiosurgery. In this case, the brain metastases were well treated with stereotactic Gamma Knife radiosurgery, and the systemic disease arising from sigmoid colon cancer has been kept under control with chemotherapies, surgical resection, and radiotherapy.

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