P16.23 Surgical resection of melanoma brain metastases a highly effective modality for local control in the era of prolonged survival from stage IV melanoma

摘要

>Introduction: Novel systemic therapies targeting the MAP kinase pathway (BRAF inhibitors) or immune checkpoints have significantly improved the overall survival of patients with metastatic melanoma, with a 2 year overall survival now above 50%. The importance of achieving durable local control of brain metastases is therefore reinforced. We sought to determine the local control rate after complete surgical resection of individual brain metastases in patients with stage IV melanoma. Secondary outcome measures were morbidity and mortality associated with these surgeries, frequency of distant recurrence of brain metastases, and overall survival. Additionally, we sought to define patterns of treatment in relation to radiation options and systemic therapies. METHODS: Clinicopathological data was retrospectively collected from 104 consecutive patients recorded in a prospective database who underwent surgical resection of 1 – 4 melanoma brain metastases between May 2008 and December 2014 at Melanoma Institute Australia and Royal Prince Alfred Hospital, Sydney Australia. Group 1 comprised all those treated between May 2008 and May 2011 (before the routine use of effective drug therapies). Group 2 comprised all those treated between June 2011 and December 2014. Given the marked heterogeneity between the treatment the two groups have received, we felt that statistical analyses for direct comparisons would be inappropriate. >Results: Group 1 had 46 patients with a total of 78 cerebral melanoma metastatic lesions resected and Group 2 had 58 patients with a total of 106 lesions resected. The local control rate at 24 months was 91% in both Group 1 and Group 2. The median overall survival was higher in Group 2 than Group 1, as reflected by 13.5 months and 11.5 months respectively. The use of whole brain radiation therapy, systemic therapy, stereotactic ­radiosurgery (SRS) to cavity varied between the two groups, with 72%, 35%, 0% in Group 1 and 57%, 34%, 10% in Group 2, respectively. The rates of SRS failure varied between the two groups, with 4% in Group 1 and 34% in Group 2. Peri-operative complications rates and death rate of 4% and 1% respectively was detected in Group 1, and 6% and 2% respectively in Group 2. CONCLUSION: Surgical resection of melanoma brain metastases is a highly effective and safe means of local control for stage IV melanoma patients who now see prolonged survival when treated in a multimodal way by a cohesive multidisciplinary group.