The role of whole brain radiation therapy in the management of melanoma brain metastases

Radiation Oncology

Table 1 Patient characteristics and clinical covariates

			Median (IQR)	Range
Age at stereotactic radiosurgery (years)			60 (51 – 68)	28 – 92
Time from primary Melanoma to Brain Metastasis (months)			39 (17 – 69)	0 – 347
Diameter of largest brain Metasasis (mm)			11 (8 – 21)	3 – 55
			n (%)
Gender:
	Male		99 (67%)
	Female		48 (33%)
Extent of extracranial metastases:*
	0		12 (8%)
	1	Limited	28 (19%)	86 (59%)
	2		46 (31%)
	3		35 (24%)
	4	Extensive	18 (12%)	61 (41%)
	5		7 (5%)
	6		1 (1%)
Extracranial disease status:
	Absent		12 (8%)
	Present and stable		23 (16%)
	Present and progressive		112 (76%)
Number of brain metastases:
	1		59 (40%)
	2 – 3		53 (36%)
	> 3 (4–10)		35 (24%)
Karnofsky performance status:
	50 – 60		6 (4%)
	70 – 80		61 (41%)
	90 – 100		80 (54%)
Initial treatment:
			DF/BWCC	BIDMC
	SRS Alone		29 (43%)	66 (84%)
	SRS + WBRT		23 (34%)	0 (0%)
	SRS + Surgery		2 (3%)	11 (14%)
	SRS + Surgery + WBRT		14 (21%)	2 (3%)
Whole-brain radiation therapy:
			DF/BWCC	BIDMC
	Up-Front (with SRS)		37 (54%)	2 (3%)
	As Salvage Therapy		9 (13%)	24 (30%)
	Never		22 (32%)	53 (67%)
Systemic treatment with SRS: ^†
	None		78 (53%)
	Temozolomide		41 (28%)
	Other		28 (19%)
Melanoma-GPA score:
	0 – 1		23 (16%)
	2		41 (28%)
	3		44 (30%)
	4		39 (27%)

Abbreviations: IQR interquartile range, DF/BWCC Dana-Farber/Brigham & Women’s Cancer Center, BIDMC Beth Israel Deaconess Medical Center, SRS stereotactic radiosurgery, WBRT whole brain radiation therapy, Melanoma-GPA melanoma-specific Graded Prognostic Assessment for brain metastases.
*To define the “extent of extracranial metastases”, each patient was assigned a number between 0 and 6 based on evidence of melanoma metastases to the following 6 sites: liver, lung, adrenal glands, other visceral organs, bone, or other distant site (e.g. lymph nodes or subcutaneous tissue). The median number of extracranial body sites affected by metastatic melanoma is 2. “Limited extracranial metastases” was defined as ≤ 2 extracranial body sites affected by metastatic melanoma. “Extensive extracranial metastases” was defined as ≥ 3 extracranial body sites affected by metastatic melanoma.
^†Systemic Treatment with SRS = systemic treatment given after SRS and before disease progression.

ISSN: 1748-717X