Brain and leptomeningeal metastases from cutaneous melanoma: Survival outcomes based on clinical features Journal Article
| Authors: | Raizer, J. J.; Hwu, W. J.; Panageas, K. S.; Wilton, A.; Baldwin, D. E.; Bailey, E.; Von Althann, C.; Lamb, L. A.; Alvarado, G.; Bilsky, M. H.; Gutin, P. H. |
| Article Title: | Brain and leptomeningeal metastases from cutaneous melanoma: Survival outcomes based on clinical features |
| Abstract: | Brain metastases (BM) are among the most devastating and debilitating complications of melanoma. This retrospective study was conducted to gain a better understanding of patient and disease characteristics that have the greatest impact on overall survival in melanoma patients with BM; therapeutic interventions were also assessed. The records of all patients diagnosed with cutaneous melanoma and BM who were seen at Memorial Sloan-Kettering Cancer Center between 1991 and 2001 were retrospectively reviewed. A variety of factors, including age at diagnosis of stage IV disease, gender, race, disease stage at diagnosis, presence of BM at diagnosis of stage IV disease, neurologic symptoms, radiographic findings, number of BM, status and site(s) of extracranial metastasis, and treatment modalities, were analyzed for correlation with overall survival using univariate and multivariate Cox regression models. The records of 355 patients with BM were included in the analysis. On univariate analysis, seven patient and disease characteristics were significantly associated with poorer survival: age > 65 years, extracranial metastases, BM at stage IV diagnosis, neurologic symptoms, four or more BM, hydrocephalus, and leptomeningeal metastases. Of these, age, extracranial metastasis, neurologic symptoms, and number of BM were significantly associated with poorer survival in a multivariate analysis. Multivariate analysis of treatment modalities suggested that patients who had surgery, radiosurgery, or chemotherapy with temo-zolomide had improved survival outcomes, although this analysis has limitations. The prognostic factors identified in this retrospective study should be considered when making treatment decisions for patients with BM and used as stratification factors in future clinical trials. Copyright 2008 by the Society for Neuro-Oncology. |
| Keywords: | survival; adolescent; adult; cancer chemotherapy; cancer survival; child; controlled study; preschool child; school child; aged; aged, 80 and over; child, preschool; middle aged; patient satisfaction; cancer surgery; retrospective studies; major clinical study; overall survival; clinical feature; mortality; anamnesis; cancer localization; multimodality cancer therapy; cancer radiotherapy; temozolomide; cancer staging; brain tumor; brain neoplasms; cancer diagnosis; medical decision making; melanoma; metastasis; multiple cycle treatment; skin neoplasms; clinical assessment; pathology; retrospective study; kaplan-meiers estimate; cancer center; skin tumor; proportional hazards model; meningeal neoplasms; radiosurgery; brain metastasis; multivariate analysis; seizure; meningioma; kaplan meier method; gender; univariate analysis; neurologic disease; tumor bleeding; meningeal metastasis; race; brain metastases; hydrocephalus; leptomeninx; cox regression model |
| Journal Title: | Neuro-Oncology |
| Volume: | 10 |
| Issue: | 2 |
| ISSN: | 1522-8517 |
| Publisher: | Oxford University Press |
| Date Published: | 2008-04-01 |
| Start Page: | 199 |
| End Page: | 207 |
| Language: | English |
| DOI: | 10.1215/15228517-2007-058 |
| PUBMED: | 18287337 |
| PROVIDER: | scopus |
| PMCID: | PMC2613822 |
| DOI/URL: | |
| Notes: | --- - "Cited By (since 1996): 15" - "Export Date: 17 November 2011" - "CODEN: NEURJ" - "Source: Scopus" |
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