gms | German Medical Science

Objective: Brain metastases are a common complication in malignant melanoma. The prognosis is usually poor. The aim of the current study was to retrospectively evaluate neurosurgically treated patients with cerebral metastases of malignant melanoma (CMMM) with respect to clinical presentation, recurrent disease, survival and factors affecting survival.

Methods: 34 patients (19 f / 15 m) with CMMM were treated between 2000 and 2010. Patient data was analysed with respect to clinical factors, outcome and prognosis. Mean age at time of diagnosis of a CMMM was 58 years (32–80 years). 22 patients (64.7%) had a single CMMM, whereas 12 patients (35.3%) showed two or more CMMM. Survival curves were estimated by the Kaplan-Meier-method and factors affecting prognosis were evaluated using the Mantel-Cox log rank test.

Results: Median survival of patients with a single CMMM was 13.0 months (m) (95%-CI 9.3–16.7), this was significantly (p = 0.014) better than for patients with two or more CMMM (median 5.0 m, 95%-CI 3.4–14.6). Tumour size, localization, bleeding, performance status, neurological symptoms or extracranial tumour status did not show any significant effect on overall survival. 19/34 patients (55.9%) developed a second CMMM after microsurgical resection of a first CMMM. Patients with an isolated intracerebral relapse survived significantly (p = 0.003) longer (median 6.0 m, 95%-CI 0–15.3) than those with systemic progression (median 3.0 m, 95%-CI 1.7–4.3). Similarly, patients with a Karnowsky score (KPS) ≥ 70% survived significantly (p = 0.001) longer (median 7.0 m, 95%-CI 0.0–19.9 vs 1.0 m, 95%-CI 0.0–2.2). 11/19 patients (57.9%) received local therapy (microsurgery (n = 6) or radiosurgery (n = 5)). Patients with local therapy showed a significantly (p = 0.011) improved survival as compared to patients treated by whole brain radiation, chemotherapy or supportive therapy (median 6.0 m, 95%-CI 3.8–8.2 vs 3.0 m, 95%-CI 1.8–4.2). KPS was available in 10/11 patients receiving local treatment and remained unchanged pre- and posttherapeutically (mean KPS = 86.0%). Mean KPS was 69.0% during last follow-up.

Conclusions: After primary diagnosis of a CMMM, the number of CMMM was the only factor affecting overall survival in our population. After diagnosis of an intracranial relapse, systemic progression, KPS and local treatment were shown to influence outcome. Even though prognosis is poor, in selective patients with a good performance status and isolated intracranial relapse, local retreatment can be justified.