Brain metastasis after immunotherapy in patients with metastatic melanoma or renal cell cancer: Is craniotomy indicated?

The purpose of this study was to evaluate the outcome of surgical treatment of brain metastasis in patients with metastatic melanoma or renal cell can cer after interleukin-2 (IL-2) therapy. A retrospective analysis was conduc ted at the Surgery Branch, National Cancer Institute. All patients with a d iagnosis of metastatic melanoma or renal cell cancer who received IL-2 from January 1, 1985 to January 1, 1996 (n = 1385) were screened for the develo pment of brain metastasis, Forty patients underwent surgical treatment of b rain metastasis that developed after initiating IL-2 therapy. Thirty-six we re rendered free of disease after resection of a single metastasis and were the focus of this study. Twenty-two of the 36 patients achieved a clinical response (10 complete responses and 12 partial responses) at extracranial sites of disease after IL-2-based immunotherapy and before the development of brain metastasis. The median disease-free interval in the brain after re section of a single metastasis was 21, 7, and 3 months for patients achievi ng a complete response, pal tial response, and no response (CR, PR, and NR) to IL-2 therapy, respectively. The median survival after craniotomy for th ese three groups of patients was 23, 17, and 7 months, respectively. The di sease-free interval in the brain and the overall survival after craniotomy were significantly longer for patients achieving a CR to previous immunothe rapy when compared with patients achieving a PR or NR. Of the 10 patients w ho had achieved a prior CR, 8 remained disease free in the brain at last fo llow-up, 6 remained alive beyond 1 year, and 3 >4 years. Twenty-five patien ts experienced neurologic symptoms before craniotomy and all had complete r esolution of their symptoms after surgery. Surgical treatment of single bra in metastasis in patients with metastatic melanoma or renal cell cancer is indicated in carefully selected patients. The benefits of resection include palliation of symptoms and the potential for a prolonged disease-free inte rval in the brain.