Brain metastases from malignant melanoma: conventional vs. high-dose-per-fraction radiotherapy

This report examines the records of 72 patients who received various regimens of radiotherapy for cerebral metastases from malignant melanoma at NYU Medical Center. Treatment consisted of whole-brain irradiation, either with dose fractions of 300 cGy (conventional fractionation, CF) or 500-600 cGy (high-dose-per-fraction, HDF) to a total of 3000 cGy. Two-thirds of the patients responded to radiotherapy as measured by improvement of at least one functional level. No difference in response could be attributed to dose schedules, either overall or in the subgroups of patients who had solitary or multiple brain metastases. Median survival was not significantly affected by fractionation schedule; however, patients who had solitary metastases survived longer, probably because of the nature of their disease. Treatment related toxicity was more frequent in the HDF group. The subgroup of patients who had their only clinically demonstrable lesion grossly excised prior to treatment survived more than twice as long as other patients. We conclude that radiotherapy is effective in palliating symptoms for these patients. Our data does not support the use of HDF techniques in the treatment of patients with brain metastases from malignant melanoma.