Treatment of Metastatic Melanoma to the Brain

Melanoma is the sixth most common form of cancer in the United States. Moreover, it is the third most common type of tumor to metastasize into the brain. Clinical studies have shown that 10-40% of patients with melanoma will eventually develop metastatic disease within the brain. In addition, the number of patients afflicted with brain metastases continues to rise as advances in chemotherapy provide increased survival time for patients with other forms of systemic disease. Still, the prognosis for patients with brain metastases remains poor. Melanoma is largely radioresistant, thus limiting treatment options. Studies have shown that as many as 90% of patients will die as a result of their intracranial disease. Left untreated, most patients show rapid deterioration and subsequent death. Even with treatment, the median survival time is two to three months. The goal of therapy for the treatment of metastatic melanoma is to provide palliation of symptoms and prolongation of survival. Current methods of treatment consist of Whole Brain Radiation Therapy, Stereotaxic Radiosurgery, chemotherapy, immunotherapy, and surgical resection of the intracranial lesion. Recent clinical trials have examined the effects of combined treatments. Evidence has indicated better results when two or more treatment options are used together. In this retrospective study, we attempted to evaluate the effects of planned radiosurgery or radiation treatment following surgical resection of the primary lesion in 38 patients. We compared these results against treatment with surgery or radiosurgery alone. Results indicated that surgery was most effective when followed by planned radiation or radiosurgery. This minimized the risk of remaining tumor foci and provided treatment to other, smaller lesions. Patients receiving these combined treatments had greater survival rates, fewer postoperative symptoms, and a lower incidence of disease recurrence when compared with patients treated only with surgery or radiosurgery