Metastatic melanoma in brain. Rapid treatment or large dose fractions

A subgroup of 59 patients selected on the basis of favorable prognostic factors from a larger group of 194 patients treated for intracranial metastases of melanoma was analyzed with a view to assessing the relative efficacy of different accelerated fractionation regimens. The most effective modification of the previously standard therapy was a shortening of the overall treatment time, although this was also associated with the use of larger doses per fraction. Patients who had brain metastases only at the time of treatment showed a longer survival time than those with coexistent metastases in other organs and survived longer if treated with 10 fractions within 1 week rather than 20 fractions in 2 weeks. The same was found in patients who underwent complete resection of intracranial tumor before irradiation. A complete surgical resection also increased the probability of eliminating intracranial disease, but overall the median survival increased by less than 2 months. It is concluded that a short overall treatment time is more important than large fraction sizes in attempts to improve the treatment of metastatic intracranial melanomas with favorable prognosis.