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. 2014 Dec;82(6):1250-5.
doi: 10.1016/j.wneu.2013.02.025. Epub 2013 Feb 10.

Predictors of survival, neurologic death, local failure, and distant failure after gamma knife radiosurgery for melanoma brain metastases

Matthew T Neal  1 , Michael D Chan  2 , John T Lucas Jr  2 , Amritraj Loganathan  3 , Christine Dillingham  3 , Edward Pan  4 , John H Stewart 4th  5 , J Daniel Bourland  2 , Edward G Shaw  2 , Stephen B Tatter  3 , Thomas L Ellis  3
Affiliations

Predictors of survival, neurologic death, local failure, and distant failure after gamma knife radiosurgery for melanoma brain metastases

Matthew T Neal et al. World Neurosurg. 2014 Dec.

Abstract

Objective: This study sought to assess clinical outcomes in patients receiving gamma knife radiosurgery (GK) for treatment of brain metastases from melanoma and evaluate for potential predictive factors.

Methods: We reviewed 188 GK procedures in 129 consecutive patients that were treated for brain metastases from melanoma. The population consisted of 84 males and 45 females with a median age of 57 years. Fifty-five patients (43%) had a single metastasis. Seventy-one patients (55%) received chemotherapy, 58 patients (45%) received biologic agents, and 36 patients (28%) received prior whole brain radiation therapy (WBRT). The median marginal dose was 18.8 Gy (range 12 to 24 Gy).

Results: Actuarial survival was 52%, 26%, and 13% at 6, 12, and 24 months, respectively. The median survival time was 6.7 months. Local tumor control was 95%, 81% 53% at 6, 12, and 24 months, respectively. The median time to LBF was 25.2 months. Freedom from distant brain failure was 40%, 29%, and 10% at 6, 12, and 24 months, and the median time to DBF was 4.6 months. At the time of data analysis, 108 patients (84%) had died. Fifty-eight patients (52%) died from neurologic death. The median time to neurologic death from GK treatment was 7.9 months. Multivariate analysis revealed that hemorrhage of metastases prior to GK (P = .02) and LBF (P = .03) were the dominant predictors of neurologic death.

Conclusions: GK achieves excellent local control and may improve outcomes as a component of a multidisciplinary treatment strategy. Distant brain failure and neurologic demise remain problematic and prospective trials are necessary.

Keywords: Brain metastasis; Gamma knife; Hemorrhage; Melanoma; Neurologic death; Stereotactic radiosurgery.

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Conflict of interest statement

Conflict of interest statement: The authors declare that the article content was composed in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Figures

Figure 1.
Figure 1.
Kaplan-Meier plot of overall survival.
Figure 2.
Figure 2.
Kaplan-Meier plot of freedom from local failure.
Figure 3.
Figure 3.
Kaplan-Meier plot of freedom from distant failure.
See this image and copyright information in PMC

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