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Determinants of Outcome in Melanoma Patients With Cerebral Metastases

From the Sydney Melanoma Unit, Departments of Radiation Oncology and Neurosurgery, Royal Prince Alfred Hospital; and Department of Surgery, University of Sydney, Sydney, New South Wales, Australia.

Address reprint requests to John F. Thompson, MD, Sydney Melanoma Unit, Royal Prince Alfred Hospital, Missenden Rd, Camperdown, NSW 2050, Australia; e-mail: john.thompson{at}email.cs.nsw.gov.au

PURPOSE: To analyze prognostic factors, effects of treatment, and survival for patients with cerebral metastases from melanoma.

PATIENTS AND METHODS: All melanoma patients with cerebral metastases treated at the Sydney Melanoma Unit between 1952 and 2000 were identified. From 1985 to 2000, patients were diagnosed and treated using consistent modern techniques and this cohort was analyzed in detail. Multivariate analysis of prognostic factors for survival was performed.

RESULTS: A total of 1,137 patients with cerebral metastases were identified; 686 were treated between 1985 and 2000. For these 686 patients, the median time from primary diagnosis to cerebral metastasis was 3.1 years (range, 0 to 41 years). A total of 646 patients (94%) have died as a result of melanoma. The median survival from the time of diagnosis of cerebral metastasis was 4.1 months (range, 0 to 17.2 years). Treatment was as follows: surgery and postoperative radiotherapy, 158 patients; surgery alone, 47 patients; radiotherapy alone, 236 patients; and supportive care alone, 210 patients. Median survival according to treatment received for these four groups was 8.9, 8.7, 3.4, and 2.1 months, respectively; the differences between surgery and nonsurgery groups were statistically significant. On multivariate analysis, significant factors associated with improved survival were surgical treatment (P < .0001), no concurrent extracerebral metastases (P < .0001), younger age (P = .0007), and longer disease-free interval (P = .036). Prognostic factors analysis confirmed the important influence of patient selection on treatment received.

CONCLUSION: This large series documents the characteristics of patients who developed cerebral metastases from melanoma. Median survival was dependent on treatment, which in turn was dependent on patient selection.

Supported by the Melanoma Foundation of the University of Sydney and the Melanoma and Skin Cancer Research Institute.

Authors' disclosures of potential conflicts of interest are found at the end of this article.

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