Skip to main content

Main menu

  • Home
  • Current Issue
  • Archive
  • Info for
    • Authors
    • Advertisers
    • Editorial Board
  • Other Publications
    • Anticancer Research
    • Cancer Genomics & Proteomics
    • Cancer Diagnosis & Prognosis
  • More
    • IIAR
    • Conferences
  • About Us
    • General Policy
    • Contact
  • Other Publications
    • In Vivo
    • Anticancer Research
    • Cancer Genomics & Proteomics

User menu

  • Register
  • Subscribe
  • My alerts
  • Log in
  • My Cart

Search

  • Advanced search
In Vivo
  • Other Publications
    • In Vivo
    • Anticancer Research
    • Cancer Genomics & Proteomics
  • Register
  • Subscribe
  • My alerts
  • Log in
  • My Cart
In Vivo

Advanced Search

  • Home
  • Current Issue
  • Archive
  • Info for
    • Authors
    • Advertisers
    • Editorial Board
  • Other Publications
    • Anticancer Research
    • Cancer Genomics & Proteomics
    • Cancer Diagnosis & Prognosis
  • More
    • IIAR
    • Conferences
  • About Us
    • General Policy
    • Contact
  • Visit iiar on Facebook
  • Follow us on Linkedin
Research ArticleClinical Studies

A Simple Implement for Assessing the Survival of Elderly Patients With Melanoma Irradiated for Cerebral Metastases

TRANG NGUYEN, STEFAN JANSSEN, STEVEN E. SCHILD and DIRK RADES
In Vivo May 2020, 34 (3) 1361-1364; DOI: https://doi.org/10.21873/invivo.11914
TRANG NGUYEN
1Department of Radiation Oncology, University of Lübeck, Lübeck, Germany
  • Find this author on Google Scholar
  • Find this author on PubMed
  • Search for this author on this site
STEFAN JANSSEN
1Department of Radiation Oncology, University of Lübeck, Lübeck, Germany
2Medical Practice for Radiotherapy and Radiation Oncology, Hannover, Germany
  • Find this author on Google Scholar
  • Find this author on PubMed
  • Search for this author on this site
STEVEN E. SCHILD
3Department of Radiation Oncology, Mayo Clinic, Scottsdale, AZ, U.S.A.
  • Find this author on Google Scholar
  • Find this author on PubMed
  • Search for this author on this site
DIRK RADES
1Department of Radiation Oncology, University of Lübeck, Lübeck, Germany
  • Find this author on Google Scholar
  • Find this author on PubMed
  • Search for this author on this site
  • For correspondence: rades.dirk@gmx.net
  • Article
  • Figures & Data
  • Info & Metrics
  • PDF
Loading

Abstract

Background/Aim: Secondary brain lesions occur commonly in patients with advanced melanoma. Despite increasing use of local therapies, many elderly patients qualify for whole-brain radiotherapy (WBRT). For these patients, a survival score was created. Patients and Methods: Seven characteristics were retrospectively investigated in 35 elderly (≥65 years) patients with melanoma, namely WBRT regimen, age, gender, Karnofsky performance score (KPS), number of brain lesions, non-cerebral metastases and interval from melanoma diagnosis to WBRT. Results: Age ≤71 years (p=0.044) and KPS ≥80% (p=0.005) were significantly associated with more favorable survival. Based on these characteristics, patients received 0 (n=13), 1 (n=12) or 2 points (n=10). Two prognostic groups were designed, 0 or 1 point vs. 2 points, with actuarial 6-month survival rates of 12% and 48%, respectively (p=0.002). Conclusion: This simple implement allows quick estimation of the survival of elderly patients receiving WBRT for cerebral metastases from melanoma.

  • Melanoma
  • cerebral metastases
  • elderly patients
  • whole-brain radiotherapy
  • survival
  • prognostic tool

Melanomas account for 5-10% of malignant tumors spreading to the brain (1). For many patients with few secondary brain lesions, local therapies, namely surgery and different types of stereotactic radiotherapy, are used, either alone or combined with systemic therapies (2-6). In patients with more than a few lesions, whole-brain radiotherapy (WBRT) is quite often delivered. Many patients with melanoma developing cerebral metastases belong to the age group of 65 years and older. This group requires particular attention, since these patients more often have other diseases and reduced function of organs such as liver, kidney and bone marrow compared to younger patients. Elderly patients may be unable to withstand intensive local and systemic therapies and, therefore, receive WBRT alone. For the treatment of cerebral metastases, different WBRT regimens are available including 5×4 Gy (overall treatment time of 1 week), 10×3 Gy (2 weeks) and regimens with doses beyond 30 Gy (35-40 Gy with fractions of 2.0-3.0 Gy each, lasting 2.5 to 4 weeks). When selecting a WBRT regimen for an elderly patient with melanoma, physicians should consider the remaining lifespan. For patients with a reduced lifespan, short-term WBRT (i.e. 5×4 Gy) appears to be appropriate, since this regimen was shown to have similar outcomes compared to longer programs in patients with poor survival prognoses (7). On the contrary, for patients expected to have longer remaining lifetime, longer-term WBRT regimens may be beneficial in terms of increased cerebral control and survival (8). Therefore, physicians would like to be able to estimate a patient's prognosis before the start of WBRT. This study was performed to support physicians during the decision-making process. It aimed to create a simple tool that allows estimating the survival prognosis following WBRT of elderly patients with melanoma presenting with cerebral metastases.

Patients and Methods

Thirty-five melanoma patients aged ≥65 years, who received WBRT for cerebral metastases, were analyzed in a retrospective way within this study, which received approval from the Ethics Committee (AZ19-011A). The data of several patients had been obtained from an existing database and had been used for other retrospective studies (9-13). In the current study, WBRT regimen (5×4 Gy vs. 10×3 Gy vs. 12-20×2-3 Gy) and six pre-WBRT characteristics were analyzed for associations with survival. Distributions of the seven characteristics are shown in Table I. Pre-WBRT characteristics were age (≤71 vs. ≥72 years, median=72 years), gender (female vs. male), Karnofsky performance score (≤70% vs. ≥80%, median=70%), number of cerebral tumors [1-3 (limited) vs. ≥4 (multiple)], non-cerebral metastases (no vs. yes), and period from melanoma diagnosis until WBRT (≤34 vs. ≥35 months, median=34 months).

View this table:
  • View inline
  • View popup
  • Download powerpoint
Table I.

Distribution of the evaluated characteristics.

The survival analyses were performed with Kaplan-Meier method plus log-rank test. Characteristics that were significantly (p<0.05) associated with survival after WBRT were used to create the prognostic tool. For each significant characteristic, points were assigned, namely 0 points in the case of less favorable survival and 1 point in the case of more favorable survival. The total points for patients were calculated by adding their individual points related to significant characteristics.

Results

Age ≤71 years (p=0.044) and KPS of ≥80% (p=0.005) were significantly associated with more favorable outcomes (Table II). Therefore, these characteristics were used to create the prognostic tool. The following points were assigned: 0 points for age ≥72 years and KPS of ≤70%, respectively, and 1 point for age ≤71 years and KPS of ≥80%. Thus, the patients received total scores of 0 (n=13), 1 (n=12) or 2 points (n=10). Survival rates were 8%, 25% and 60% at 3 months, and 8%, 17% and 48% at 6 months (p=0.007). Two prognostic groups were designed, with 0 or 1 point, and 2 points. Corresponding 3-month survival rates were 16% and 60%; 6-month survival rates were 12% and 48%, respectively (p=0.002, Figure 1).

Discussion

Considerable research is carried out to improve the survival prognoses of patients with metastatic melanoma (2-6, 9-13). The prognoses of many elderly patients developing cerebral metastases from melanoma are very limited. Besides newer systemic treatment approaches, personalization of the treatment can lead to improved outcomes. To facilitate the selection of an optimally personalized treatment, survival scores are important. This also applies to the choice of the most appropriate WBRT regimen. Survival scores are already available for different types of radiotherapy and primary tumor types (4, 9, 10, 14). In our study, a specific implement for estimating the survival prognoses of elderly patients receiving WBRT for cerebral metastases from melanoma has been added. Patients belonging to the 0-to-1-point group achieved a median survival of only 1 month, and 3- and 6-month survival rates were only 16% and 12%, respectively. Thus, these patients should receive short-term WBRT with 5×4 Gy (7). Moreover, since a randomized study performed in patients with cerebral metastases from lung cancer and quite limited prognoses demonstrated that best supportive care was not significantly inferior to the same regimen plus WBRT with 5×4 Gy, one may also consider omitting WBRT for the patients of the 0-to-1-point group in the present study (15).

View this table:
  • View inline
  • View popup
  • Download powerpoint
Table II.

Six-month survival rates after whole-brain irradiation (univariate analyses).

On the contrary, patients of the 2-point group in the current study achieved a median survival of 6 months, with the 3- and 6-month survival of 60% and 48%, respectively. Thus, these patients would appear to be more adequately treated with a longer-term WBRT program, since previous studies have suggested increased cerebral control and survival using WBRT with higher doses (8). In general, the outcomes of patients developing cerebral metastases from melanoma may be improved by combining radiotherapy and immunotherapy (16). This applies particularly to those who have intermediate or favorable prognoses. However, one should be aware of the increased risk of side-effects including necrosis of normal brain tissue when immunotherapy is added. When using this new tool to estimate a patient's survival time and to select a WBRT regimen, the limitations of our study, namely its small sample size and its retrospective design, need to be regarded.

Figure 1.
  • Download figure
  • Open in new tab
  • Download powerpoint
Figure 1.

Kaplan-Meier curves of the groups with 0-1 points (n=25) and 2 points (n=10) with respect to survival after whole-brain radiotherapy.

In summary, a simple tool was developed that allows judging the remaining lifespans of elderly patients treated with WBRT for cerebral metastases from melanoma. This tool can be useful when aiming to pick the most suitable individual WBRT regimen.

Footnotes

  • Authors' Contributions

    T.N., S.J., S.E.S. and D.R. participated in the study design. T.N., S.J. and D.R. provided the data that were analyzed and interpreted by S.E.S. and D.R. S.E.S. and D.R. wrote the article that was reviewed and approved by all Authors.

  • This article is freely accessible online.

  • Conflicts of Interest

    On behalf of all Authors, the corresponding Author states that there are no conflicts of interest related to this study.

  • Received February 24, 2020.
  • Revision received March 5, 2020.
  • Accepted March 6, 2020.
  • Copyright© 2020, International Institute of Anticancer Research (Dr. George J. Delinasios), All rights reserved

References

  1. ↵
    1. Siegel RL,
    2. Miller KD,
    3. Jemal A
    : Cancer statistics, 2019. CA Cancer J Clin 69: 7-34, 2019. PMID: 30620402. DOI: 10.3322/caac.21551
    OpenUrlCrossRefPubMed
  2. ↵
    1. Stera S,
    2. Balermpas P,
    3. Blanck O,
    4. Wolff R,
    5. Wurster S,
    6. Baumann R,
    7. Szücs M,
    8. Loutfi-Krauss B,
    9. Wilhelm ML,
    10. Seifert V,
    11. Rades D,
    12. Rödel C,
    13. Dunst J,
    14. Hildebrandt G,
    15. Arnold A,
    16. Meissner M,
    17. Kähler KC
    : Stereotactic radiosurgery combined with immune checkpoint inhibitors or kinase inhibitors for patients with multiple brain metastases of malignant melanoma. Melanoma Res 29: 187-195, 2019. PMID: 30802230. DOI: 10.1097/CMR.0000000000000542
    OpenUrl
    1. Huttenlocher S,
    2. Dziggel L,
    3. Hornung D,
    4. Blanck O,
    5. Schild SE,
    6. Rades D
    : A new prognostic instrument to predict the probability of developing new cerebral metastases after radiosurgery alone. Radiat Oncol 9: 215, 2014. PMID: 25240823. DOI: 10.1186/1748-717X-9-215
    OpenUrlPubMed
  3. ↵
    1. Sehmisch L,
    2. Huttenlocher S,
    3. Schild SE,
    4. Rades D
    : Estimating survival of patients receiving radiosurgery alone for cerebral metastasis from melanoma. J Dermatol 41: 918-921, 2014. PMID: 25154301. DOI: 10.1111/1346-8138.12599
    OpenUrl
    1. Azijli K,
    2. Stelloo E,
    3. Peters GJ,
    4. van den Eertwegh AJ
    : New developments in the treatment of metastatic melanoma: immune checkpoint inhibitors and targeted therapies. Anticancer Res 34: 1493-1505, 2014. PMID: 24692676.
    OpenUrlAbstract/FREE Full Text
  4. ↵
    1. Walter L,
    2. Heinzerling L
    : BRAF inhibitors and radiation do not act synergistically to inhibit WT and V600E BRAF human melanoma. Anticancer Res 38: 1335-1341, 2018. PMID: 29491057. DOI: 10.21873/anticanres.12356
    OpenUrlAbstract/FREE Full Text
  5. ↵
    1. Rades D,
    2. Kieckebusch S,
    3. Lohynska R,
    4. Veninga T,
    5. Stalpers LJ,
    6. Dunst J,
    7. Schild SE
    : Reduction of overall treatment time in patients irradiated for more than three brain metastases. Int J Radiat Oncol Biol Phys 69: 1509-1513, 2007. PMID: 17689033. DOI: 10.1016/j.ijrobp.2007.05.014
    OpenUrlPubMed
  6. ↵
    1. Rades D,
    2. Panzner A,
    3. Dziggel L,
    4. Haatanen T,
    5. Lohynska R,
    6. Schild SE
    : Dose-escalation of whole-brain radiotherapy for brain metastasis in patients with a favorable survival prognosis. Cancer 118: 3852-3859, 2012. PMID: 22170514. DOI: 10.1002/cncr.26680
    OpenUrlPubMed
  7. ↵
    1. Rades D,
    2. Sehmisch L,
    3. Hansen HC,
    4. Dziggel L,
    5. Janssen S,
    6. Schild SE
    : Comparison of diagnosis-specific survival scores for patients with cerebral metastases from malignant melanoma including the new WBRT-30-MM. Anticancer Res 39: 1501-1505, 2019. PMID: 30842188. DOI: 10.21873/anticanres.13268
    OpenUrlAbstract/FREE Full Text
  8. ↵
    1. Sehmisch L,
    2. Schild SE,
    3. Rades D
    : Development of a survival score for patients with cerebral metastases from melanoma. Anticancer Res 37: 249-252, 2017. PMID: 28011499. DOI: 10.21873/anticanres.11314
    OpenUrlAbstract/FREE Full Text
    1. Rades D,
    2. Sehmisch L,
    3. Janssen S,
    4. Schild SE
    : Prognostic factors after whole-brain radiotherapy alone for brain metastases from malignant melanoma. Anticancer Res 36: 6637-6640, 2016. PMID: 27919995. DOI: 10.21873/anticanres.11271
    OpenUrlAbstract/FREE Full Text
    1. Meyners T,
    2. Heisterkamp C,
    3. Kueter JD,
    4. Veninga T,
    5. Stalpers LJ,
    6. Schild SE,
    7. Rades D
    : Prognostic factors for outcomes after whole-brain irradiation of brain metastases from relatively radioresistant tumors: A retrospective analysis. BMC Cancer 10: 582, 2010. PMID: 20977700. DOI: 10.1186/1471-2407-10-582
    OpenUrlPubMed
  9. ↵
    1. Rades D,
    2. Sehmisch L,
    3. Bajrovic A,
    4. Janssen S,
    5. Schild SE
    : Comparison of 20×2 Gy and 12×3 Gy for whole-brain irradiation of multiple brain metastases from malignant melanoma. In Vivo 30: 917-919, 2016. PMID: 27815480. DOI: 10.21873/invivo.11013
    OpenUrlAbstract/FREE Full Text
  10. ↵
    1. Rades D,
    2. Dziggel and,
    3. Schild SE
    : A specific survival score for patients receiving local therapy for single brain metastasis from a gynecological malignancy. In Vivo 32: 825-828, 2018. PMID: 29936465. DOI: 10.21873/invivo.11314
    OpenUrlAbstract/FREE Full Text
  11. ↵
    1. Mulvenna P,
    2. Nankivell M,
    3. Barton R,
    4. Faivre-Finn C,
    5. Wilson P,
    6. McColl E,
    7. Moore B,
    8. Brisbane I,
    9. Ardron D,
    10. Holt T,
    11. Morgan S,
    12. Lee C,
    13. Waite K,
    14. Bayman N,
    15. Pugh C,
    16. Sydes B,
    17. Stephens R,
    18. Parmar MK,
    19. Langley RE
    : Dexamethasone and supportive care with or without whole brain radiotherapy in treating patients with non-small cell lung cancer with brain metastases unsuitable for resection or stereotactic radiotherapy (QUARTZ): results from a phase 3, non-inferiority, randomised trial. Lancet 388(10055): 2004-2014, 2016. PMID: 27604504. DOI: 10.1016/S0140-6736(16)30825-X
    OpenUrlCrossRefPubMed
  12. ↵
    1. Petrelli F,
    2. De Stefani A,
    3. Trevisan F,
    4. Parati C,
    5. Inno A,
    6. Merelli B,
    7. Ghidini M,
    8. Bruschieri L,
    9. Vitali E,
    10. Cabiddu M,
    11. Borgonovo K,
    12. Ghilardi M,
    13. Barni S,
    14. Ghidini A
    : Combination of radiotherapy and immunotherapy for brain metastases: A systematic review and meta-analysis. Crit Rev Oncol Hematol 144: 102830, 2019. PMID: 31733443. DOI: 10.1016/j.critrevonc.2019.102830
    OpenUrl
PreviousNext
Back to top

In this issue

In Vivo: 34 (3)
In Vivo
Vol. 34, Issue 3
May-June 2020
  • Table of Contents
  • Table of Contents (PDF)
  • Index by author
  • Back Matter (PDF)
  • Ed Board (PDF)
  • Front Matter (PDF)
Print
Download PDF
Article Alerts
Sign In to Email Alerts with your Email Address
Email Article

Thank you for your interest in spreading the word on In Vivo.

NOTE: We only request your email address so that the person you are recommending the page to knows that you wanted them to see it, and that it is not junk mail. We do not capture any email address.

Enter multiple addresses on separate lines or separate them with commas.
A Simple Implement for Assessing the Survival of Elderly Patients With Melanoma Irradiated for Cerebral Metastases
(Your Name) has sent you a message from In Vivo
(Your Name) thought you would like to see the In Vivo web site.
CAPTCHA
This question is for testing whether or not you are a human visitor and to prevent automated spam submissions.
11 + 0 =
Solve this simple math problem and enter the result. E.g. for 1+3, enter 4.
Citation Tools
A Simple Implement for Assessing the Survival of Elderly Patients With Melanoma Irradiated for Cerebral Metastases
TRANG NGUYEN, STEFAN JANSSEN, STEVEN E. SCHILD, DIRK RADES
In Vivo May 2020, 34 (3) 1361-1364; DOI: 10.21873/invivo.11914

Citation Manager Formats

  • BibTeX
  • Bookends
  • EasyBib
  • EndNote (tagged)
  • EndNote 8 (xml)
  • Medlars
  • Mendeley
  • Papers
  • RefWorks Tagged
  • Ref Manager
  • RIS
  • Zotero
Reprints and Permissions
Share
A Simple Implement for Assessing the Survival of Elderly Patients With Melanoma Irradiated for Cerebral Metastases
TRANG NGUYEN, STEFAN JANSSEN, STEVEN E. SCHILD, DIRK RADES
In Vivo May 2020, 34 (3) 1361-1364; DOI: 10.21873/invivo.11914
del.icio.us logo Digg logo Reddit logo Twitter logo CiteULike logo Facebook logo Google logo Mendeley logo
  • Tweet Widget
  • Facebook Like
  • Google Plus One

Jump to section

  • Article
    • Abstract
    • Patients and Methods
    • Results
    • Discussion
    • Footnotes
    • References
  • Figures & Data
  • Info & Metrics
  • PDF

Related Articles

  • No related articles found.
  • PubMed
  • Google Scholar

Cited By...

  • Validation of a Graded Prognostic Model in Patients With Brain Metastases Treated With Whole-brain Radiotherapy Instead of Radiosurgery
  • Google Scholar

More in this TOC Section

  • Evaluation of TET Family Gene Expression and 5-Hydroxymethylcytosine as Potential Epigenetic Markers in Non-small Cell Lung Cancer
  • Automated Non-coplanar Volumetric Modulated Arc Therapy Planning for Maxillary Sinus Carcinoma
  • The Influence of the Rapid Increase in the Number of Adverse Event Reports for COVID-19 Vaccine on the Disproportionality Analysis Using JADER
Show more Clinical Studies

Similar Articles

Keywords

  • melanoma
  • Cerebral metastases
  • elderly patients
  • whole-brain radiotherapy
  • Survival
  • prognostic tool
In Vivo

© 2023 In Vivo

Powered by HighWire