Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2023 Feb 28;15(5):1542.
doi: 10.3390/cancers15051542.

Melanoma Brain Metastases: A Retrospective Analysis of Prognostic Factors and Efficacy of Multimodal Therapies

Valeria Internò  1   2 , Maria Chiara Sergi  2 , Maria Elvira Metta  3 , Michele Guida  4 , Paolo Trerotoli  5 , Sabino Strippoli  4 , Salvatore Circelli  2 , Camillo Porta  1   2 , Marco Tucci  1   2
Affiliations

Melanoma Brain Metastases: A Retrospective Analysis of Prognostic Factors and Efficacy of Multimodal Therapies

Valeria Internò et al. Cancers (Basel). .

Abstract

Brain metastasis in cutaneous melanoma (CM) has historically been considered to be a dismal prognostic feature, although recent evidence has highlighted the intracranial activity of combined immunotherapy (IT). Herein, we completed a retrospective study to investigate the impact of clinical-pathological features and multimodal therapies on the overall survival (OS) of CM patients with brain metastases. A total of 105 patients were evaluated. Nearly half of the patients developed neurological symptoms leading to a negative prognosis (p = 0.0374). Both symptomatic and asymptomatic patients benefited from encephalic radiotherapy (eRT) (p = 0.0234 and p = 0.011). Lactate dehydrogenase (LDH) levels two times higher than the upper limit normal (ULN) at the time of brain metastasis onset was associated with poor prognosis (p = 0.0452) and identified those patients who did not benefit from eRT. Additionally, the poor prognostic role of LDH levels was confirmed in patients treated with targeted therapy (TT) (p = 0.0015) concerning those who received immunotherapy (IT) (p = 0.16). Based on these results, LDH levels higher than two times the ULN at the time of the encephalic progression identify those patients with a poor prognosis who did not benefit from eRT. The negative prognostic role of LDH levels on eRT observed in our study will require prospective evaluations.

Keywords: brain metastases; brain metastases treatment; cutaneous melanoma; immunotherapy; melanoma brain metastases; radiotherapy.

PubMed Disclaimer

Conflict of interest statement

The authors declare no conflict of interest.

Figures

Figure 1
Figure 1
Overall survival according to (A) neurological symptoms, (B) eRT in symptomatic patients and (C) eRT in asymptomatic patients.
Figure 2
Figure 2
Overall survival of patients depending on (A) LDH levels, (B) eRT in LDH ≤ 2 ULN and (C) eRT in LDH > 2 ULN.
Figure 3
Figure 3
Overall survival by (A) eRT in TT-treated patients, (B) eRT in IT-treated patients, (C) LDH levels in TT-treated patients and (D) LDH levels in IT-treated patients.
See this image and copyright information in PMC

References

    1. Lamba N., Wen P.Y., Aizer A.A. Epidemiology of brain metastases and leptomeningeal disease. Neuro Oncol. 2021;23:1447–1456. doi: 10.1093/neuonc/noab101. - DOI - PMC - PubMed
    1. Tadros S., Ray-Chaudhury A. Pathological Features of Brain Metastases. Neurosurg. Clin. N. Am. 2020;31:549–564. doi: 10.1016/j.nec.2020.06.005. - DOI - PubMed
    1. Sandhu M.R.S., Chiang V.L., Tran T., Yu J.B., Weiss S.A., Goldberg S.B., Aboian M.S., Kluger H.M., Mahajan A. Incidence and characteristics of metastatic intracranial lesions in stage III and IV melanoma: A single institute retrospective analysis. J. Neuro-Oncol. 2021;154:197–203. doi: 10.1007/s11060-021-03813-8. - DOI - PubMed
    1. Bander E.D., Yuan M., Carnevale J.A., Reiner A.S., Panageas K.S., Postow M.A., Tabar V., Moss N.S. Melanoma brain metastasis presentation, treatment, and outcomes in the age of targeted and immunotherapies. Cancer. 2021;127:2062–2073. doi: 10.1002/cncr.33459. - DOI - PMC - PubMed
    1. Sperduto P.W., Mesko S., Li J., Cagney D., Aizer A., Lin N.U., Nesbit E., Kruser T.J., Chan J., Braunstein S., et al. Survival in Patients With Brain Metastases: Summary Report on the Updated Diagnosis-Specific Graded Prognostic Assessment and Definition of the Eligibility Quotient. J. Clin. Oncol. 2020;38:3773–3784. doi: 10.1200/JCO.20.01255. - DOI - PMC - PubMed