• Federico Pessina, Pierina Navarria, Stefano Tomatis, Luca Cozzi, Ciro Franzese, Lorenza Di Guardo, Anna Maria Ascolese, Giacomo Reggiori, Davide Franceschini, Michele Del Vecchio, Lorenzo Bello, and Marta Scorsetti.
• Department of Neurosurgical Oncology, Humanitas Cancer Center and Research Hospital, Rozzano, Italy.
• World Neurosurg. 2017 Sep 1; 105: 184-190.

ObjectiveThe incidence of brain metastases from melanoma is increasing. Several effective treatment options are now available but what can be considered the optimal therapeutic strategy is not yet defined. We evaluated the outcome of patients with brain metastatic melanoma in terms of local control rate, brain distant progression, and overall survival.MethodsThe present retrospective study includes only patients with limited brain metastases (≤4) who underwent surgery plus stereotactic radiosurgery (SRS), or SRS alone. Surgical resection was performed in patients with good Karnofsky performance score, single large brain lesions, controlled extracranial disease, and SRS alone in all other cases. Supramargical resection was performed in all patients. The prescribed radiotherapy doses were 24 Gy/1 fraction and 30 Gy in 3-5 fractions for lesions >2.5 cm. Clinical outcome was evaluated by brain magnetic resonance imaging performed 2 months after radiotherapy and then every 3 months.ResultsFrom April 2011 to October 2015, 53 patients were treated. The median age was 54 years (range, 29-82 years). Most of patients had 1-2 brain metastases (86.8%). Twelve patients (22.6%) underwent surgical resection followed by SRS on the tumor bed, and 41 (77.4%) received SRS alone. The median follow-up time was 20.9 months (range, 5.7-61.3 months). The median, 1-, 2-, 3-year overall survival were 11.8 months, 47.2%, 28%, and 21.8%, respectively. Factors recorded as influencing survival were the number of brain metastases, the melanoma-specific graded prognostic assessment score, and BRAF mutated status.ConclusionsOur data identifier a subset of patients with a more favorable outcome who could take advantage of a more aggressive local approach followed by targeted therapy.Copyright © 2017 Elsevier Inc. All rights reserved.

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