Gamma Knife Radiosurgery for Melanoma Brain Metastases
نویسنده
چکیده
Purpose: The objective of this study is to report the combined experience at Johns Hopkins University (JHU) and the Miami Neuroscience Center (MNC) in treating brain metastases from melanoma with stereotactic radiosurgery (SRS). Methods and Materials: Prospectively collected clinical and demographic data on patients with melanoma treated with Gamma Knife (GK) at JHU between 2003 and 2007 and the MNC between 1993 and 2009 were reviewed. Cox proportional hazards regression and Kaplan Meyer analyses were used to compare survival by clinical and demographic characteristics and treatment. Results: One hundred and fifty-four patients with melanoma received GK at JHU and MNC and were followed over a mean of 7.29+11.42 months (median reverse Kaplan Meier: 26.02 months). The median survival from the time of treatment was 5.03 months. Survival analysis revealed number of lesions, Karnofsky Performance Score (KPS), and dose as significant variables. Treatment center, age, and volume of metastases were not significant. Multivariate pooled analysis identified KPS <70 (HR 2.4, p<0.001), multiple (>3) lesions (HR 2.1, p <0.01), and dose<17Gy (HR 1.58, p=0.029) as a significant predictors of time to mortality from GK treatment. Conclusions: Radiosurgery seems to be better than conservative treatment only in patients with melanoma brain metastasis with favorable KPS (>70) and less than three lesions. Treatment with higher radiation dose improves the efficacy of radiosurgery. Categories: Radiation Oncology, Neurosurgery
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