Whole brain irradiation for patients with metastatic melanoma: A review of 87 cases

Purpose: We have conducted a retrospective study of the use of whole brain irradiation (WBI) for melanoma patients with brain metastases. The purpose of the study was to obtain a description of the population offered this form of treatment, an overview of radiation doses and schedules, an assessment of palliative effect, and survival. Methods and Materials: A database of melanoma patients diagnosed with brain metastases was searched to identify patients who had received WBI and for whom adequate documentation existed. Data regarding demographics, treatment, and survival were compiled. Results: Information was obtained for 87 patients. Ninety-five percent of the patients received total doses of at least 30 Gy. The frequent use of corticosteroids during treatment made it difficult to assess palliative effect. However, 52% of all patients and 48% of symptomatic patients were able to discontinue corticosteroid therapy upon completion of irradiation, suggesting that some degree of control or palliation had been obtained. In the small number of patients with postradiotherapy imaging studies, it was not uncommon to see stability or shrinkage of tumors. The median survival of the entire group was 19 weeks. Improved survival was noted for patients who underwent resection of all brain metastases (45 weeks) and for those with no extracranial disease (54 weeks). Conclusion: WBI may provide palliation for a portion of melanoma patients with brain metastasis. The outcome of these patients, however, is dominated by the aggressive nature of their systemic disease. These data serve as a baseline for comparison of new approaches for management of brain metastases from melanoma.