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Journal of Neuro-Oncology

, Volume 140, Issue 1, pp 83–88 | Cite as

Stereotactic radiosurgery for brain metastases from malignant melanoma and the impact of hemorrhagic metastases

  • Kristine Bauer-Nilsen
  • Daniel M. Trifiletti
  • Ajay Chatrath
  • Henry Ruiz-Garcia
  • Eduardo Marchan
  • Jennifer Peterson
  • Byron C. May
  • Jason P. Sheehan
Clinical Study

Abstract

Introduction

Stereotactic radiosurgery (SRS) is a common treatment modality among patients with brain metastases, particularly from malignant melanoma. Our objective was to investigate the difference in local control, toxicity, and survival among patients with hemorrhagic and solid melanoma brain metastases.

Methods

We collected demographic, treatment, local control, toxicity, and survival for 134 patients with a total of 936 intracranial melanoma metastases who underwent SRS between 1998 and 2015. Pre-radiosurgical diagnostic imaging was reviewed for evidence of hemorrhage (melanin-containing or clearly hemorrhagic).

Results

The cohort consisted of 92 men and 42 women with a mea age of 61.7 years (range 21.2–84.9) at the time of radiosurgery. Overall survival of patients with brain metastases from malignant melanoma was 42, 31, 12% at 12, 24, and 72 months from date of first SRS. At 6 months, 43% of the patients with hemorrhagic metastases had local tumor control compared to 83% of solid melanoma metastases (p < 0.001). No significant difference in toxicity was noted between the two groups. Factors that were significantly associated with time to local tumor progression on multivariate analysis include prior WBRT (HR 1.62, p = 0.003), prior chemotherapy (HR 0.69, p = 0.011), margin dose (HR 0.88, p < 0.001) and radiographic features of melanin deposition (HR 3.73, p < 0.001), or clear hemorrhage (HR 2.20, p < 0.001).

Conclusions

Our findings demonstrate that hemorrhagic intracranial melanoma metastases are associated with inferior local tumor control when treated with SRS, as compared to solid tumors. These results highlight the importance of early radiosurgery among patients with melanoma brain metastases before hemorrhage occurs.

Keywords

Hemorrhagic Solid Radiosurgery 

Notes

Compliance with ethical standards

Conflict of interest

The authors declared that they have no conflict of interest.

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Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2018

Authors and Affiliations

  • Kristine Bauer-Nilsen
    • 1
  • Daniel M. Trifiletti
    • 2
    • 3
  • Ajay Chatrath
    • 4
  • Henry Ruiz-Garcia
    • 2
  • Eduardo Marchan
    • 2
  • Jennifer Peterson
    • 2
    • 3
  • Byron C. May
    • 2
  • Jason P. Sheehan
    • 1
    • 4
  1. 1.Department of Radiation OncologyUniversity of VirginiaCharlottesvilleUSA
  2. 2.Department of Radiation OncologyMayo ClinicJacksonvilleUSA
  3. 3.Department of Neurological SurgeryMayo ClinicJacksonvilleUSA
  4. 4.Department of Neurological SurgeryUniversity of VirginiaCharlottesvilleUSA

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