Stereotactic Radiosurgery/Stereotactic Body Radiotherapy for Melanoma:
Brain metastases
Radiosurgery has been extensively applied against melanoma metastatic to the brain, producing a far better response rate than conventional radiotherapy, including a small percentage of patients with responses lasting greater than 4 years, similar to the result reported by surgical resection plus post-operative whole brain radiotherapy (9,17). Smaller lesions respond more favorably than larger lesions (18,19,20) versus 42% for lesions larger than 2 cm (18). The volume of intracranial metastatic disease appears more significant in predicting response to radiosurgery than does the number of individual metastatic lesions (20).
Although the control of individual or even multiple brain lesions with radiosurgery is encouraging, the major challenge remains control of the entire brain, with a total brain recurrence rate of 86% reported in the M.D. Anderson Hospital series at one year, in spite of high local control rates for individual lesions (18). A possible solution to this problem is the planned combination of radiosurgery with whole brain radiotherapy, though the benefit of added whole brain radiotherapy added to radiosurgery has not been clearly established for metastatic melanoma (18).
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