Surgical series of metastatic cerebral melanoma: Clinical association of resection, BRAF-mutation status, and survival
Background: Major advances in the systemic treatment of metastatic cerebral melanoma have improved patient survival. The clinical relationship between gross total resection (GTR), BRAF-mutation status, and its effects on survival in the era of targeted/immunotherapy warrants further characterization...
| Main Authors: | , , , , , , , , , |
|---|---|
| Format: | Article |
| Language: | English |
| Published: |
Elsevier
2021-06-01
|
| Series: | Interdisciplinary Neurosurgery |
| Subjects: | |
| Online Access: | http://www.sciencedirect.com/science/article/pii/S2214751920306368 |
| _version_ | 1818610250214801408 |
|---|---|
| author | M.J. Colditz S.F. Lee M. Eastgate S. Elder P. Brandis D. Anderson T. Withers R.L. Jeffree M.B. Pinkham S. Olson |
| author_facet | M.J. Colditz S.F. Lee M. Eastgate S. Elder P. Brandis D. Anderson T. Withers R.L. Jeffree M.B. Pinkham S. Olson |
| author_sort | M.J. Colditz |
| collection | DOAJ |
| description | Background: Major advances in the systemic treatment of metastatic cerebral melanoma have improved patient survival. The clinical relationship between gross total resection (GTR), BRAF-mutation status, and its effects on survival in the era of targeted/immunotherapy warrants further characterization. Method: We retrospectively reviewed survival after craniotomy for melanoma metastases in patients who also received targeted/immunotherapy and cavity radiation at four neurosurgical hospitals in Queensland, Australia from 2012 to 2019. Results: 152 craniotomies were performed in 138 patients (98 male, 40 female), 42% were BRAF-mutant with differences in median age for BRAF-mutant vs BRAF-wildtype (52 vs 64 years; p = 0.001), and GTR rates for BRAF-mutant vs BRAF-wildtype (85% vs 73%; p = 0.03). Median survival difference between BRAF-mutant vs BRAF-wildtype was 15.4 vs 11.9 months (p = 0.11). The longest median survival occurred in BRAF-mutant with GTR while the shortest occurred in BRAF-wildtype with STR (23 vs 4.5 months; p = 0.001). At three years, the proportion alive for GTR and BRAF-mutant vs GTR and BRAF-wildtype (47.9% vs 41.6%) was higher than STR and BRAF-mutant vs STR and BRAF-wildtype (15% vs 28.4%; p = 0.03). Conclusion: BRAF-mutant patients with cerebral metastases were younger, and more likely to have a higher GTR rate with greater survival than BRAF-wildtype if GTR is achieved. Gross total resection in both groups appears to be associated with survival even in the current era of more effective systemic therapies. Subtotal resection has particularly poor survival, especially for BRAF-mutant patients. |
| first_indexed | 2024-12-16T15:11:27Z |
| format | Article |
| id | doaj.art-5b57137112fe4a7f99d458eb4f257dbb |
| institution | Directory Open Access Journal |
| issn | 2214-7519 |
| language | English |
| last_indexed | 2024-12-16T15:11:27Z |
| publishDate | 2021-06-01 |
| publisher | Elsevier |
| record_format | Article |
| series | Interdisciplinary Neurosurgery |
| spelling | doaj.art-5b57137112fe4a7f99d458eb4f257dbb2022-12-21T22:26:57ZengElsevierInterdisciplinary Neurosurgery2214-75192021-06-0124101075Surgical series of metastatic cerebral melanoma: Clinical association of resection, BRAF-mutation status, and survivalM.J. Colditz0S.F. Lee1M. Eastgate2S. Elder3P. Brandis4D. Anderson5T. Withers6R.L. Jeffree7M.B. Pinkham8S. Olson9Neurosurgery Princess Alexandra Hospital, Woolloongabba, Queensland 4102, Australia; Kenneth G Jamieson Department of Neurosurgery, Royal Brisbane and Women’s Hospital, Herston, Queensland 4029, Australia; Corresponding author at: Neurosurgery Princess Alexandra Hospital, Woolloongabba, Queensland 4102, Australia.Medical Oncology Royal Brisbane and Women’s Hospital, Herston, Queensland 4029, Australia; Medical Oncology, Ipswich Hospital, Ipswich, Queensland 4305, AustraliaMedical Oncology Royal Brisbane and Women’s Hospital, Herston, Queensland 4029, Australia; Mayne School of Medicine, University of Queensland, St Lucia, Queensland, AustraliaNeurosurgery Princess Alexandra Hospital, Woolloongabba, Queensland 4102, AustraliaNeurosurgery Princess Alexandra Hospital, Woolloongabba, Queensland 4102, AustraliaNeurosurgery Gold Coast University Hospital, Southport, Queensland 4215, AustraliaNeurosurgery Townsville University Hospital, Douglas, Queensland 4814, AustraliaKenneth G Jamieson Department of Neurosurgery, Royal Brisbane and Women’s Hospital, Herston, Queensland 4029, Australia; Mayne School of Medicine, University of Queensland, St Lucia, Queensland, AustraliaMayne School of Medicine, University of Queensland, St Lucia, Queensland, Australia; Gamma Knife Centre of Queensland, Princess Alexandra Hospital, Woolloongabba, Queensland 4102, AustraliaKenneth G Jamieson Department of Neurosurgery, Royal Brisbane and Women’s Hospital, Herston, Queensland 4029, Australia; Mayne School of Medicine, University of Queensland, St Lucia, Queensland, Australia; Gamma Knife Centre of Queensland, Princess Alexandra Hospital, Woolloongabba, Queensland 4102, AustraliaBackground: Major advances in the systemic treatment of metastatic cerebral melanoma have improved patient survival. The clinical relationship between gross total resection (GTR), BRAF-mutation status, and its effects on survival in the era of targeted/immunotherapy warrants further characterization. Method: We retrospectively reviewed survival after craniotomy for melanoma metastases in patients who also received targeted/immunotherapy and cavity radiation at four neurosurgical hospitals in Queensland, Australia from 2012 to 2019. Results: 152 craniotomies were performed in 138 patients (98 male, 40 female), 42% were BRAF-mutant with differences in median age for BRAF-mutant vs BRAF-wildtype (52 vs 64 years; p = 0.001), and GTR rates for BRAF-mutant vs BRAF-wildtype (85% vs 73%; p = 0.03). Median survival difference between BRAF-mutant vs BRAF-wildtype was 15.4 vs 11.9 months (p = 0.11). The longest median survival occurred in BRAF-mutant with GTR while the shortest occurred in BRAF-wildtype with STR (23 vs 4.5 months; p = 0.001). At three years, the proportion alive for GTR and BRAF-mutant vs GTR and BRAF-wildtype (47.9% vs 41.6%) was higher than STR and BRAF-mutant vs STR and BRAF-wildtype (15% vs 28.4%; p = 0.03). Conclusion: BRAF-mutant patients with cerebral metastases were younger, and more likely to have a higher GTR rate with greater survival than BRAF-wildtype if GTR is achieved. Gross total resection in both groups appears to be associated with survival even in the current era of more effective systemic therapies. Subtotal resection has particularly poor survival, especially for BRAF-mutant patients.http://www.sciencedirect.com/science/article/pii/S2214751920306368SurgeryBrain metastasisMelanomaResectionBRAF |
| spellingShingle | M.J. Colditz S.F. Lee M. Eastgate S. Elder P. Brandis D. Anderson T. Withers R.L. Jeffree M.B. Pinkham S. Olson Surgical series of metastatic cerebral melanoma: Clinical association of resection, BRAF-mutation status, and survival Interdisciplinary Neurosurgery Surgery Brain metastasis Melanoma Resection BRAF |
| title | Surgical series of metastatic cerebral melanoma: Clinical association of resection, BRAF-mutation status, and survival |
| title_full | Surgical series of metastatic cerebral melanoma: Clinical association of resection, BRAF-mutation status, and survival |
| title_fullStr | Surgical series of metastatic cerebral melanoma: Clinical association of resection, BRAF-mutation status, and survival |
| title_full_unstemmed | Surgical series of metastatic cerebral melanoma: Clinical association of resection, BRAF-mutation status, and survival |
| title_short | Surgical series of metastatic cerebral melanoma: Clinical association of resection, BRAF-mutation status, and survival |
| title_sort | surgical series of metastatic cerebral melanoma clinical association of resection braf mutation status and survival |
| topic | Surgery Brain metastasis Melanoma Resection BRAF |
| url | http://www.sciencedirect.com/science/article/pii/S2214751920306368 |
| work_keys_str_mv | AT mjcolditz surgicalseriesofmetastaticcerebralmelanomaclinicalassociationofresectionbrafmutationstatusandsurvival AT sflee surgicalseriesofmetastaticcerebralmelanomaclinicalassociationofresectionbrafmutationstatusandsurvival AT meastgate surgicalseriesofmetastaticcerebralmelanomaclinicalassociationofresectionbrafmutationstatusandsurvival AT selder surgicalseriesofmetastaticcerebralmelanomaclinicalassociationofresectionbrafmutationstatusandsurvival AT pbrandis surgicalseriesofmetastaticcerebralmelanomaclinicalassociationofresectionbrafmutationstatusandsurvival AT danderson surgicalseriesofmetastaticcerebralmelanomaclinicalassociationofresectionbrafmutationstatusandsurvival AT twithers surgicalseriesofmetastaticcerebralmelanomaclinicalassociationofresectionbrafmutationstatusandsurvival AT rljeffree surgicalseriesofmetastaticcerebralmelanomaclinicalassociationofresectionbrafmutationstatusandsurvival AT mbpinkham surgicalseriesofmetastaticcerebralmelanomaclinicalassociationofresectionbrafmutationstatusandsurvival AT solson surgicalseriesofmetastaticcerebralmelanomaclinicalassociationofresectionbrafmutationstatusandsurvival |