STEREOTAXIC RADIOSURGERY FOR CEREBRAL METASTATIC MELANOMA

To determine local tumor control rates and survival of patients with m elanoma metastases to the brain, the authors reviewed the results of 2 3 consecutive patients with a total of 32 tumors (19 patients had a so litary tumor and four had multiple tumors) who underwent adjuvant ster eotactic radiosurgerv. Tumor locations included the cerebral hemispher e (24 cases). brain stem (four cases), basal ganglia (two cases), and cerebellum (two cases). Fifteen patients had associated cranial sympto matology and eight had incidental metastases. All patients had tumors of 3 cm or less in diameter (mean tumor volume 2.5 cu cm), and all rec eived fractionated whole-brain radiation therapy (30 Gy) in addition t o radiosurgerv (mean tumor margin dose 16 Gy). Nineteen patients were managed with both modalities at the time of diagnosis; four underwent radiosurgery 3 to 12 months after fractionated whole-brain radiotherap y. The mean patient follow-up period was 12 months (range 3 to 38 mont hs). After radiosurgery, eight patients improved, 13 remained stable, and two deteriorated. One patient subsequently required craniotomy bec ause of intratumoral hemorrhage; this patient and three others are liv ing 13 to 38 months after radiosurgery. Nineteen patients died, 18 fro m progression of their systemic disease and one from another hemorrhag e into a new brain metastasis. The local tumor control rate was 97%. O nly two patients subsequently developed new intracranial metastases. T he median survival period after diagnosis was 9 months (range 3 to 38 months). The authors believe that stereotactic radiosurgery coupled wi th fractionated whole-brain irradiation is an effective management str ategy for cerebral metastases from a melanoma. Multi-institutional tri als are warranted to confirm that stereotactic radiosurgery results eq ual or surpass the outcome achieved with craniotomy and tumor resectio n.