Open AccessHigh frequency of brain metastases after adjuvant therapy for high‐risk melanoma
Author(s) -
Samlowski Wolfram E.,
Moon James,
Witter Merle,
Atkins Michael B.,
Kirkwood John M.,
Othus Megan,
Ribas Antoni,
Sondak Ver K.,
Flaherty Lawrence E.
Publication year - 2017
Publication title -
cancer medicine
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.403
H-Index - 53
ISSN - 2045-7634
DOI - 10.1002/cam4.1223
Subject(s) - medicine , melanoma , tumor progression , oncology , randomization , lymphadenectomy , progression free survival , randomized controlled trial , incidence (geometry) , surgery , chemotherapy , lymph node , cancer , cancer research , physics , optics
The incidence of CNS progression in patients with high‐risk regional melanoma (stages IIIAN 2a‐ IIIC ) is not well characterized. Data from the S0008 trial provided an opportunity to examine the role of CNS progression in treatment failure and survival. All patients were surgically staged. Following wide excision and full regional lymphadenectomy, patients were randomized to receive adjuvant biochemotherapy ( BCT ) or high‐dose interferon alfa‐2B ( HDI ). CNS progression was retrospectively identified from data forms. Survival was measured from date of CNS progression. A total of 402 eligible patients were included in the analysis ( BCT : 199, HDI : 203). Median follow‐up (if alive) was over 7 years (range: 1 month to 11 years). The site of initial progression was identifiable in 80% of relapsing patients. CNS progression was a component of systemic melanoma relapse in 59/402 patients (15% overall). In 34/402 patients (9%) CNS progression represented the initial site of treatment failure. CNS progression was a component of initial progression in 27% of all patients whose melanoma relapsed (59/221). The risk of CNS progression was highest within 3 years of randomization. The difference in CNS progression rates between treatment arms was not significant ( BCT = 25, HDI = 34, P = 0.24). Lymph node macrometastases strongly associated with CNS progression ( P = 0.001), while ulceration and head and neck primaries were not significant predictors. This retrospective analysis of the S0008 trial identified a high brain metastasis rate (15%) in regionally advanced melanoma patients. Further studies are needed to establish whether screening plus earlier treatment would improve survival following CNS progression.