Metastatic melanoma: Surgical treatment of brain metastases - Analysis of 110 patients

J Clin Neurosci. 2020 Mar:73:144-149. doi: 10.1016/j.jocn.2019.12.063. Epub 2020 Jan 16.

Abstract

New Zealand has one of the highest rates of melanoma in the world. In up to 10% of cases, the disease is metastatic at diagnosis. Cerebral metastatic involvement carries a particularly poor prognosis. 110 patients were included in the analysis. A retrospective consecutive series of patients treated surgically at Auckland City Hospital were studied, with parameters of demographics, tumour characteristics, surgery, pathology, systemic therapy and survival analysed. Mean age was 59.9 years (range 22-81 years). Median survival from date of surgery was 8.1 months (95% CI 6.9-9.4 months). Of the 58 patients tested for BRAF mutation, 28 were positive, similar to previously published data. This conferred a better prognosis with median overall survival of 12.3 months (95% CI 7.2-17.3 months) compared to 7.8 months (95% CI 5.6-10 months) for those who were negative (p < 0.05). Survival correlated positively with extent of surgical resection. Both BRAF positive status and targeted and/or immunotherapy were significant predictors of improved survival. In this cohort, radiation therapy did not show a statistically significant improvement in overall survival. Survival from resection of cerebral metastases from melanoma is improving. Survival benefit is conferred by BRAF mutation, solitary metastasis and gross total resection of lesion.

Keywords: Cerebral metastases; Melanoma; Prognostic factors, brain; Surgical resection.

MeSH terms

  • Adult
  • Aged
  • Aged, 80 and over
  • Antineoplastic Agents, Immunological / therapeutic use
  • Brain Neoplasms / mortality
  • Brain Neoplasms / secondary*
  • Brain Neoplasms / surgery*
  • Chemotherapy, Adjuvant / methods
  • Chemotherapy, Adjuvant / mortality
  • Combined Modality Therapy / methods
  • Female
  • Humans
  • Male
  • Melanoma / mortality
  • Melanoma / pathology*
  • Melanoma / surgery*
  • Melanoma, Cutaneous Malignant
  • Middle Aged
  • Neurosurgical Procedures / methods
  • Neurosurgical Procedures / mortality
  • New Zealand
  • Prognosis
  • Radiotherapy, Adjuvant / methods
  • Radiotherapy, Adjuvant / mortality
  • Retrospective Studies
  • Skin Neoplasms / mortality
  • Skin Neoplasms / pathology*
  • Skin Neoplasms / surgery*
  • Young Adult

Substances

  • Antineoplastic Agents, Immunological