Stereotactic surgery of malignant melanoma brain metastases

Since 2007, the Oncology Institute of Ljubljana carried out 97 SRS procedures, 9 of which were performed in patients with malignant melanoma brain metastases. Another patient was treated with hyperfractionated stereotactic radiotherapy (hfSRT), as the irradiated area was too large for irradiation with SRS and, based on the radiobiological characteristics of the tumour, we decided for targeted radiation therapy with a higher daily dose (6). Median survival was 30 weeks for all malignant melanoma patients, with the same survival time until local recurrence of the disease. Following SRS, there were less local recurrences among patients compared to progressions or recurrences of the disease outside the central nervous system (CNS). The irradiation dose delivered to patients treated with SRS was 22.5 Gy (20-25) in a single dose. The patient treated with hfSRT received 30 Gy in total, namely 5 doses of 6 Gy. Eight out of nine patients also received WBRT, and one was treated with WBRT after the first surgery for brain metastases and did not receive it after the SRS. The patient treated with hfSRT due to systemic therapy administered after radiation therapy (vemurafenib) did not receive WBRT and experienced disease progression in the CNS outside the irradiated three months later. The response was achieved in all patients (a stable disease in 4 patients, a partial response in 4 patients, a complete response in 1 patient), with patients with a stable disease experiencing disease progression outside the CNS a few weeks after the therapy. A complete response was achieved in one patient, but six months later, he also experienced disease progression in the CNS outside the SRS area