Intracerebral metastases of malignant melanoma and their recurrences--a clinical analysis

Abstract

Introduction: Brain metastases (BM) commonly occur in patients with metastatic malignant melanoma (MM). Prognosis is poor even with maximal therapy. The aim of the current study was to retrospectively evaluate patients with BM of MM who were treated neurosurgically with respect to clinical presentation, recurrent disease, survival and factors affecting survival.

Patients and methods: Thirty-four patients (19f/15m) with BM of MM were treated in our hospital between 2000 and 2010. Patient data were analysed, survival was examined using Kaplan-Meier-estimates and factors affecting prognosis were evaluated using uni- and multivariate analysis.

Results: Twenty-two patients (64.7%) had a single BM, whereas twelve patients (35.3%) revealed two or more lesions. Median survival for patients with a single BM was 13.0 months (95%-CI 9.3-16.7 months), this was significantly (p=0.014) better than for patients with two or more BM (median 5.0, 95%-CI 3.4-14.6 months). Nineteen patients (55.9%) developed an intracranial relapse after microsurgical resection of a first lesion. Patients with an isolated intracerebral relapse survived significantly (p=0.003) longer than those with systemic progression (median 6.0, 95%-CI 0.0-15.3 months vs median 3.0, 95%-CI 1.7-4.3 months). Similarly, patients with a high performance status showed significantly (p=0.001) prolonged survival (median 7.0, 95%-CI 0.0-19.9 months vs median 1.0, 95%-CI 0.0-2.2 months). Eleven out of nineteen patients (57.9%) underwent either another microsurgical resection (n=6) or stereotactic radiosurgery (n=5). These patients remained on a high performance status even after aggressive therapy.

Discussion: Even though the prognosis for patients with BM of MM is generally poor, patients with a single BM can benefit from microsurgical resection. However, there is a high risk of intracranial relapse. In selected patients with a good performance status and recurrent intracranial disease, recurrent local therapy can be justified and useful.

Keywords: Brain metastasis; Malignant melanoma; Neurosurgery; Prognostic factors; Recurrence; Reoperation.