Skip to main content
SpringerLink
Log in

Whole brain irradiation and temozolomide based chemotherapy in melanoma brain metastases

  • Research Articles
  • Published:
Clinical & Translational Oncology Aims and scope Submit manuscript

Abstract

Introduction

Whole brain irradiation (WBRT) remains a recommended treatment for patients with brain metastases from malignant melanoma in terms of symptom palliation, especially when extracranial systemic disease is present. Temozolomide (TMZ) has shown efficacy in the treatment of metastatic melanoma. The objective was to evaluate the potential benefit in survival of two different schedules of total dose and fractionation (20 Gy/5 fractions vs 30 Gy/10 fractions) and further TMZ based chemotherapy.

Materials and method

We have conducted a retrospective study in a group of twenty-one patients (RTOG Recursive Partitioning Analysis class II) of the use of WBRT with 20 Gy/5 fractions (n=11) and 30 Gy/10 fractions (n=10). All patients received further TMZ based chemotherapy administered as a single chemotherapeutic agent or in combination with chemo-immunotherapy.

Results

Prognostic variables such as: age, Karnofsky performance status, extracranial metastases and number of brain metastases, were analyzed in both groups of treatment without statistically significant differences. The median survival time (MST) for WBRT 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 significant differences (Log rank p=0.74). There was one complete response and two partial responses.

Conclusions

The results suggest that MST was not significantly affected by the total dose/fractionation schedule.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  1. Madajewicz S, Karakousis C, West CR, Caracandas J, Avellanosa AM. Malignant melanoma brain metastases. Review of Roswell Park Memorial Institute experience. Cancer. 1984;53:2550–2.

    Article  PubMed  CAS  Google Scholar 

  2. Chao JH, Phillips R, Nickson JJ. Roentgen-ray therapy of cerebral metastases. Cancer. 1954;7:682–9.

    Article  PubMed  CAS  Google Scholar 

  3. Carella RJ, Gelber R, Hendrickson F, Berry HC, Cooper JS. Value of radiation therapy in the management of patients with cerebral metastases from malignant melanoma: Radiation Therapy Oncology Group Brain Metastases Study I and II. Cancer. 1980;45:679–83.

    Article  PubMed  CAS  Google Scholar 

  4. Buchsbaum JC, Suh JH, Lee S-Y, Chidel MA, Greskovich JF, Barnett GH. Survival by Radiation Therapy Oncology Group Recursive Partitioning Analysis Class and treatment modality in patients with brain metastases from malignant melanoma. A retrospective study, Cancer. 2002;94:2265–72.

    Article  PubMed  Google Scholar 

  5. Yung WK, Prados MD, Yaya-Tur R, et al. Multicenter phase II trial of temozolomide in patients with anaplastic astrocytoma or anaplastic oligoastrocytoma at first relapse. J Clin Oncol. 1999;17:2762–71.

    PubMed  CAS  Google Scholar 

  6. Bleehen NM, Newlands ES, Lee SM, et al. Cancer Research Campaign phase II trial of temozolomide in metastatic melanoma. J Clin Oncol. 1995;15:910–3.

    Google Scholar 

  7. Franke W, Neumann N, Richter-Hintz D, Ruzicka T, Klaus W. Temozolomide-A promising agent in the therapy of brain metastases in malignant melanoma. In: American Society of Clinical Oncology 36th Annual Meeting, New Orleans, May 20–23, 2000, Prog Proc Am Soc Clin Oncol. 2000;19:575.

    Google Scholar 

  8. Biasco G, Pantaleo MA, Casadei S. Treatment of brain metastases of malignant melanoma with temozolomide. N Engl J Med. 2001;345:621.

    Article  PubMed  CAS  Google Scholar 

  9. Conill C, Puig S, Toscas I, Castel T. Complete response of cerebral metastasic melanoma after a combined treatment of radiotherapy and temozolomide. Med Clin (Barc). 2002;119(19):758–9.

    Google Scholar 

  10. Conill C, Fernández-Ibiza J, Malvehy J, Puig S, Sánchez M, Castel T. Temozolomide in patients with melanoma brain metastases treated with whole brain irradiation. Med Clin (Barc). 2004;122:413–5.

    Article  Google Scholar 

  11. Karnofsky DA, Abelmann WH, Craver LF, Burchenal JH. The use of nitrogen mustards in the palliative treatment of cancer. Cancer. 1948;1:634–56.

    Article  Google Scholar 

  12. Conill, C, Verger E, Salamero M. Performance status assessment in cancer patients. Cancer. 1990;65:1864–6.

    Article  PubMed  CAS  Google Scholar 

  13. Gaspar LE, Scott Ch, Murray K, Curran W. Validation of the RTOG recursive partitioning analysis (RPA) classification for brain metastases. Int J Radiat Oncol Biol Phys. 2000;47:1001–6.

    Article  PubMed  CAS  Google Scholar 

  14. Ellerhorst J, Strom E, Nardone E, McCutcheon I. Whole brain irradiation for patients with metastatic melanoma: a review of 87 cases. Int J Radiat Oncol Biol Phys. 2001;49:93–7.

    Article  PubMed  CAS  Google Scholar 

  15. Konefal JB, Emami B, Pilepich MV. Analysis of dose fractionation in the palliation of metastases from malignant melanoma. Cancer. 1988;61:243–6.

    Article  PubMed  CAS  Google Scholar 

  16. Bafaloukos D, Tsoutsos D, Fountzilas G, et al. The effect of temozolomide-based chemotherapy in patients with cerebral metastases from melanoma. Melanoma Research. 2004;14:289–94.

    Article  PubMed  CAS  Google Scholar 

  17. Ulrich J, Gademann G, Gollnick H. Management of cerebral metastases from malignant melanoma: results of a combined, simultaneous treatment with fotemustine and irradiation. J Neuro Oncol. 1999;43: 173–8.

    Article  CAS  Google Scholar 

  18. Mornex F, Thomas L, Mohr P, et al. A prospective randomized multicentre phase III trial of fotemustine plus whole brain irradiation versus fotemustine alone in cerebral metastases of malignant melanoma. Melanoma Research. 2003;13:97–103.

    Article  PubMed  CAS  Google Scholar 

  19. Margolin K, Atkins MB, Thompson JA, et al. Temozolomide and whole brain irradiation in melanoma metastatic to the brain: A phase II trial of the Cytokine Working Group. J Cancer Res Clin Oncol. 2002;128:214–8.

    Article  CAS  Google Scholar 

  20. Paul MJ, Summers Y, Calvert AH, et al. Effect of temozolomide on central nervous system relapse in patients with advanced melanoma. Melanoma Res. 2002; 12:175–8.

    Article  PubMed  CAS  Google Scholar 

  21. Conill C, González-Cao M, Jorcano S, et al. Temozolomide as prophylaxis for melanoma brain metastases. Melanoma Res. 2004;14:73–4.

    Article  PubMed  CAS  Google Scholar 

  22. Conill C, Jorcano S, Pujol T, Malvehy J. Radiation leukoencephalopathy. Clinical and radiological evolution. Med Clin (Barc). 2004;125:437.

    Article  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Radiation Oncology Hospital Clinic. Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), University of barcelona, Villarroel, 170, 08036, Barcelona, Spain

    Carlos Conill & Sandra Jorcano

  2. Department of Medical Oncology Hospital Clinic. Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), University of Barcelona, Barcelona, Spain

    Josep Domingo-Doménech & Rosa Gallego

  3. Department of Dermatology Hospital Clinic. Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), University of Barcelona, Barcelona, Spain

    Josep Malvehy, Susana Puig & Teresa Castel

  4. Department of Radiodiagnostics Hospital Clinic. Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), University of Barcelona, Barcelona, Spain

    Marcelo Sánchez

  5. Department of Immunology Hospital Clinic. Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), University of Barcelona, Barcelona, Spain

    Ramón Vilella

Authors
  1. Carlos Conill
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Sandra Jorcano
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Josep Domingo-Doménech
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Rosa Gallego
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Josep Malvehy
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Susana Puig
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Marcelo Sánchez
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Ramón Vilella
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. Teresa Castel
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Carlos Conill.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Conill, C., Jorcano, S., Domingo-Doménech, J. et al. Whole brain irradiation and temozolomide based chemotherapy in melanoma brain metastases. Clin Transl Oncol 8, 266–270 (2006). https://doi.org/10.1007/BF02664937

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Issue Date:

  • DOI: https://doi.org/10.1007/BF02664937

Key words

Search

Navigation