Malignant melanoma and radiotherapy: past myths, excellent local control in 146 studied lesions at Georgetown University, and improving future management

Abstract OBJECTIVE To evaluate the efficacy of CyberKnife (Accuray, Inc., Sunnyvale, CA) stereotactic radiosurgery (SRS) for patients with brain metastases of malignant melanoma and renal cell carcinoma. METHODS We conducted a retrospective review of all patients treated by image-guided radiosurgery at our institution between March 1999 and December 2005. Sixty-two patients with 145 brain metastases of renal cell carcinoma or melanoma were identified. RESULTS The median follow-up period was 10.5 months. Forty-four patients had malignant melanoma, and 18 patients had renal cell carcinoma. The median age was 57 years, and patients were classified as recursive partitioning analysis Class 1 (6 patients), 2 (52 patients) or 3 (4 patients). Thirty-three patients had been treated systemically with either chemotherapy or immunotherapy, and 33 patients were taking corticosteroids at the time of treatment. The mean tumor volume was 1.47 mL (range, 0.02–35.7 mL), and the mean prescribed dose was 20 Gy (range, 14–24 Gy). The median survival after SRS was 8.3 months. Actuarial survival at 6 and 12 months was 57 and 37%, respectively. On multivariate analysis, Karnofsky Performance Scale score (P < 0.01) and previous immunotherapy/clinical trial (P = 0.01) significantly affected overall survival. One-year intracranial progression-free survival was 38%, and local control was 87%. Intracranial control was impacted by whole-brain radiotherapy (P = 0.01), previous chemotherapy (P = 0.01), and control of the primary at the time of SRS (P = 0.02). Surgical resection had no effect on intracranial or local control. Radiographic evidence of radiation necrosis developed in 4 patients (6%). CONCLUSION CyberKnife radiosurgery provided excellent local control with acceptable toxicity in patients with melanoma or renal cell brain metastases. Initial SRS alone appeared to be a reasonable option, as survival was dictated by systemic disease.

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Outcome with stereotactic radiosurgery (SRS) and ipilimumab (Ipi) for malignant melanoma brain metastases.

Journal of Clinical Oncology ◽

10.1200/jco.2013.31.15_suppl.3032 ◽

2013 ◽

Vol 31 (15_suppl) ◽

pp. 3032-3032 ◽

Cited By ~ 6

Author(s):

Sana Shoukat ◽

David Mitchell Marcus ◽

Monica Rizzo ◽

David H. Lawson ◽

Yuan Liu ◽

...

Keyword(s):

Malignant Melanoma ◽

Brain Metastases ◽

Local Control ◽

Performance Status ◽

Ecog Performance Status ◽

Entire Cohort ◽

Kaplan Meier ◽

Patient Reported ◽

Melanoma Brain Metastases ◽

Secondary Endpoints

3032 Background: SRS with Ipi for brain metastases from malignant melanoma has been explored for overall survival (OS) (Knisely JP, Yu JB, Flanigan J, et al. Radiosurgery for melanoma brain metastases in the ipilimumab era and the possibility of longer survival. J Neurosurg. 2012;117:227-33). We present the first retrospective analysis to determine if this combination is safe and improves OS, while accounting for lactate dehydrogenase (LDH). Methods: Patients with melanoma brain metastases who underwent SRS between 1998-2010 (n=124) were compared with those who additionally received Ipi (n=11). The primary endpoint was median OS from time of SRS, calculated using Kaplan-Meier method. Cox proportional hazard model was carried out for univariate and multivariable survival analysis. The secondary endpoints were local control at initial site of SRS, anywhere intra-cranial failure, need for repeat SRS, and toxicity. Results: Median OS for the entire cohort was 6.9 months. Patients in the Ipi group had an improved median OS of 28.3 months vs. 6.8 months in the non-Ipi group (p = 0.013). No difference was noted in local control, anywhere intracranial failures, toxicity (radionecrosis, hemorrhage, patient reported memory deficits), or need for repeated SRS. MVA (Table) showed that Ipi independently predicted for improved OS even when taking into account LDH and ECOG performance status. The only confounding factor within the Ipi group was younger age of the Ipi cohort (43 vs. 55 yrs, p = 0.006). Conclusions: Use of SRS with Ipi appears to be safe and associated with an impressive increase in median OS in patients with brain metastases from malignant melanoma; this combination should be further investigated. [Table: see text]

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Surgery alone versus post-operative radiotherapy for sinonasal malignant melanoma: a meta-analysis

The Journal of Laryngology & Otology ◽

10.1017/s0022215118002189 ◽

2018 ◽

Vol 132 (12) ◽

pp. 1051-1060

Author(s):

R Hu ◽

B-B Yang

Keyword(s):

Overall Survival ◽

Malignant Melanoma ◽

Local Control ◽

Meta Analysis ◽

Disease Free Survival ◽

Free Survival ◽

Rare Malignancy ◽

One Year ◽

Disease Free ◽

Sinonasal Malignant Melanoma

AbstractObjectiveSinonasal malignant melanoma is a relatively rare malignancy with poor prognosis, and effective treatments remain elusive. This analysis aimed to explore whether post-operative radiotherapy conferred any survival advantages in patients with this disease when compared with surgery alone.MethodsPublished studies were identified by searching four electronic databases. The endpoints evaluated were: rates of overall survival, disease-free survival and local control.ResultsTwenty-eight studies including 1392 patients were identified. The results indicated that post-operative radiotherapy led to a significantly better three-year overall survival rate (p= 0.02), and suggested a borderline significant benefit for five-year overall survival (p= 0.05), when compared with surgery alone. However, no statistical advantage was found for disease-free survival, local control or one-year overall survival.ConclusionThis meta-analysis indicated that adjuvant radiotherapy prolonged survival, but showed no benefit for disease-free survival or local control.

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Effective local control of malignant melanoma by intratumoural injection of a beta-emitting radionuclide

European Journal of Nuclear Medicine and Molecular Imaging ◽

10.1007/s00259-001-0696-y ◽

2001 ◽

Vol 29 (2) ◽

pp. 221-230 ◽

Cited By ~ 14

Author(s):

Jong Lee ◽

Woo Yang ◽

Min-Geol Lee ◽

Young Ryu ◽

Jeon Park ◽

...

Keyword(s):

Malignant Melanoma ◽

Local Control ◽

Intratumoural Injection

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Local control of malignant melanoma by radiation

International Journal of Radiation Oncology*Biology*Physics ◽

10.1016/0360-3016(77)90543-0 ◽

1977 ◽

Vol 2 ◽

pp. 126 ◽

Cited By ~ 1

Author(s):

Allan H. Rappaport ◽

Theodore L. Phillips

Keyword(s):

Malignant Melanoma ◽

Local Control

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Abdominoperineal Resection Provides Better Local Control But Equivalent Overall Survival to Local Excision of Anorectal Malignant Melanoma

Annals of Surgery ◽

10.1097/sla.0000000000000862 ◽

2015 ◽

Vol 261 (4) ◽

pp. 670-677 ◽

Cited By ~ 26

Author(s):

Akihisa Matsuda ◽

Masao Miyashita ◽

Satoshi Matsumoto ◽

Goro Takahashi ◽

Takeshi Matsutani ◽

...

Keyword(s):

Overall Survival ◽

Malignant Melanoma ◽

Abdominoperineal Resection ◽

Local Excision ◽

Local Control ◽

Anorectal Malignant Melanoma

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DNCB for local control of malignant melanoma: don??t forget a winning horse!

Melanoma Research ◽

10.1097/00008390-199612000-00008 ◽

1996 ◽

Vol 6 (6) ◽

pp. 457-459 ◽

Cited By ~ 2

Author(s):

Aliza Adler

Keyword(s):

Malignant Melanoma ◽

Local Control

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Long-term outcomes after carbon-ion radiotherapy for oral mucosal malignant melanoma

Journal of Radiation Research ◽

10.1093/jrr/rrw117 ◽

2016 ◽

Vol 58 (4) ◽

pp. 517-522 ◽

Cited By ~ 8

Author(s):

Kensuke Naganawa ◽

Masashi Koto ◽

Ryo Takagi ◽

Azusa Hasegawa ◽

Hiroaki Ikawa ◽

...

Keyword(s):

Overall Survival ◽

Malignant Melanoma ◽

Local Control ◽

Significant Risk ◽

Carbon Ion Radiotherapy ◽

Significant Prognostic Factor ◽

Effective Treatment Option ◽

Carbon Ion ◽

Mucosal Malignant Melanoma

Abstract Oral mucosal malignant melanoma (OMM) is extremely rare and has a poor prognosis. Owing to its rarity, it has not yet been possible to establish an optimal treatment modality. The objective of this study was to evaluate the long-term efficacy of carbon-ion radiotherapy (C-ion RT) for OMM. Between 1997 and 2013, 19 patients with OMM were treated with C-ion RT alone. Patient ages ranged from 44 to 84 years (median, 69 years). Nine men and 10 women were included. OMMs were restaged in accordance with the seventh edition of the tumour/node/metastasis (TNM) Staging System of the International Union Against Cancer. Before treatment, 14 patients had T3 disease and 5 had T4a disease. Three patients were classified as having N1 disease. All patients were classified as having M0. The hard palate was the most frequently involved oral subsite. All patients were treated with 57.6 Gy (relative biological effectiveness) in 16 fractions. The median follow-up period was 61 months (range, 8–190 months). The 5-year local control, overall survival and progression-free survival rates were 89.5%, 57.4% and 51.6%, respectively. For local control and overall survival, T classification was found to be a significant prognostic factor. Grade 2 and 3 osteoradionecrosis was observed in three and four patients, respectively. The presence of teeth within the planning target volume was a significant risk factor for developing osteoradionecrosis. C-ion RT was an effective treatment option with acceptable toxicity for OMM.

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