Whole brain irradiation and temozolomide based chemotherapy in melanoma brain metastases

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ABSTRACT

Introduction. Whole brain irradiation (WBRT) remainsa recommended treatment for patients withbrain metastases from malignant melanoma interms of symptom palliation, especially when extracranialsystemic disease is present. Temozolomide(TMZ) has shown efficacy in the treatment ofmetastatic melanoma. The objective was to evaluatethe potential benefit in survival of two differentschedules of total dose and fractionation (20 Gy/5fractions vs 30 Gy/10 fractions) and further TMZbased chemotherapy.Materials and method. We have conducted a retrospectivestudy in a group of twenty-one patients(RTOG Recursive Partitioning Analysis class II) ofthe use of WBRT with 20 Gy/5 fractions (n = 11)and 30 Gy/10 fractions (n = 10). All patients receivedfurther TMZ based chemotherapy administered asa single chemotherapeutic agent or in combinationwith chemo-immunotherapy.Results. Prognostic variables such as age, Karnofskyperformance status, extracranial metastases andnumber of brain metastases, were analyzed in bothgroups of treatment without statistically significantdifferences. The median survival time (MST) forWBRT 20 Gy group was 4 months (CI 95% range 2-6 months) and for WBRT 30 Gy group was 4 months(CI 95% range 0-7 months) without statistically significantdifferences ( Log rank p = 0.74). There wasone complete response and two partial responses.Conclusions. The results suggest that MST was notsignificantly affected by the total dose/fractionationschedule