Melanomas metastáticos intracranianos: análise de 13 casos

Araújo, João Flávio Mattos; Sperlescu, Alexander; Melacci, Eduardo Barros; Balbo, Roque José

doi:10.1590/S0004-282X1997000200018

Resumos

Os autores apresentam análise retrospectiva de 13 pacientes com o diagnóstico de melanoma metástico intracerebral. A lesão primária foi detectada em 9 pacientes. A idade dos pacientes variou entre 28 e 84 anos. O tempo transcorrido entre o diagnóstico da lesão primária e a metástase cerebral variou entre 6 e 60 meses. Todos os pacientes foram submetidos a craniotomia, com remoção da lesão. A mortalidade nos primeiros 30 dias foi zero. A sobrevida dos pacientes variou entre 2 e 55 meses. O tempo médio de sobrevida de todo o grupo foi 14 meses. Embora o tratamento cirúrgico não seja curativo, a sobrevida é significativamente prolongada. Os critérios para a indicação da cirurgia, radioterapia e quimioterapia são discutidos.

metástase cerebral; melanoma maligno; tratamento cirúrgico

The authors present a retrospective review of 13 patients with the diagnostic of intracranial metastatic malignant melanoma. Their ages ranged from 28 to 84 years. The time interval from diagnosis of primary tumor to development of cerebral metastases ranged from 6 to 60 months. There was preoperative evidence of extracranial disease in 9 patients. All patients underwent craniotomy, and the 30-day mortality was zero. The patients survived 2 to 55 months after surgery. Medium survival time for all patients was 14 months. The excision of metastatic melanoma from the brain, although not curative, may increase survival in patients with this metastatic cancer. The criteria for consideration of surgery, radiotherapy and chemotherapy are discussed.

cerebral metastasis; malignant melanoma; surgical management

Melanomas metastáticos intracranianos: análise de 13 casos

Malignant melanoma brain metastases: analysis of 13 cases

João Flávio Mattos Araújo^I; Alexander Sperlescu^II; Eduardo Barros Melacci^III; Roque José Balbo^IV

^IDepartamernto de Neuro-Psiquiatria da Faculdade de Ciências Médicas da Pontifícia Universidade Católica de Campinas e Departamento de Neurologia do Hospital Vera Cruz, Campinas: Neurocirurgião

^IIDepartamernto de Neuro-Psiquiatria da Faculdade de Ciências Médicas da Pontifícia Universidade Católica de Campinas e Departamento de Neurologia do Hospital Vera Cruz, Campinas: Professor Assistente

^IIIDepartamernto de Neuro-Psiquiatria da Faculdade de Ciências Médicas da Pontifícia Universidade Católica de Campinas e Departamento de Neurologia do Hospital Vera Cruz, Campinas: Médico Residente

^IVDepartamernto de Neuro-Psiquiatria da Faculdade de Ciências Médicas da Pontifícia Universidade Católica de Campinas e Departamento de Neurologia do Hospital Vera Cruz, Campinas: Professor Adjunto

RESUMO

Os autores apresentam análise retrospectiva de 13 pacientes com o diagnóstico de melanoma metástico intracerebral. A lesão primária foi detectada em 9 pacientes. A idade dos pacientes variou entre 28 e 84 anos. O tempo transcorrido entre o diagnóstico da lesão primária e a metástase cerebral variou entre 6 e 60 meses. Todos os pacientes foram submetidos a craniotomia, com remoção da lesão. A mortalidade nos primeiros 30 dias foi zero. A sobrevida dos pacientes variou entre 2 e 55 meses. O tempo médio de sobrevida de todo o grupo foi 14 meses. Embora o tratamento cirúrgico não seja curativo, a sobrevida é significativamente prolongada. Os critérios para a indicação da cirurgia, radioterapia e quimioterapia são discutidos.

Palavras-chave: metástase cerebral, melanoma maligno, tratamento cirúrgico.

ABSTRACT

The authors present a retrospective review of 13 patients with the diagnostic of intracranial metastatic malignant melanoma. Their ages ranged from 28 to 84 years. The time interval from diagnosis of primary tumor to development of cerebral metastases ranged from 6 to 60 months. There was preoperative evidence of extracranial disease in 9 patients. All patients underwent craniotomy, and the 30-day mortality was zero. The patients survived 2 to 55 months after surgery. Medium survival time for all patients was 14 months. The excision of metastatic melanoma from the brain, although not curative, may increase survival in patients with this metastatic cancer. The criteria for consideration of surgery, radiotherapy and chemotherapy are discussed.

Key words: cerebral metastasis, malignant melanoma, surgical management.

Texto completo disponível apenas em PDF.

Full text available only in PDF format.

Aceite: 16-dezembro-l996.

Dr. João Flávio Mattos Araújo - Departamento Neurologia do Hospital Vera Cruz - Avenida Andrade Neves 402 - 13013-900 Campinas SP - Brasil.

1. Brega K, Robinson WA, Winston K, Wittenberg W. Surgical treatment of brain metastases in malignant melanoma. Cancer 1990;66:2105-2110.
2. Choi KN, Withers R, Rotman M. Metastatic melanoma in brain: rapid treatment or large dose fractions. Cancer 1985;56:10-15.
3. Davey P, O'Brien P. Disposition of cerebral metastases from malignant melanoma: implications for radiosurgery. Neurosurgery 1991;28:8-14.
4. Dolan RA. .Successful removal of solitary metastatic cerebral malignant melanoma: case report. Surg Neurol 1993;39:466-468.
5. Fell DA, Leavens ME, McBride CM. Surgical versus nonsurgical management of metastatic melanoma of the brain. Neurosurgery 1980;7:238-242.
6. Fernandez E, Maira G. Puca A, Vignati A. Multiple intracranial metastases of malignant melanoma with long-term survival. JNeurosurg 1984;60:621-624.
7. Fletcher WS, Daniels DS, Sondak VK, Dana B, Townsend R, Hynes HE, Hutchins LF, Pancoast JR. Evaluation of cisplatin and DTIC in inoperable stage IIII and IV melanoma. Am J Clin Oncol 1993;16:359-362.
8. Hugen NA, Cirrincione C, Thaler HT, DeAngelis LM. The role of radiation therapy following resection of single brain metastasis from melanoma. Neurology 1990;40:158-160.
9. Kim MK, Warren TC, Kimball ES. Purification and characterization of a low molecular weight transforming growth factor from the urine of melanoma patients. J Biol Chem 1985:260:9237-9243.
10. Legha S, Ring S, Plager C. Evaluation of a triple-drug regimen containing cisplatin, vinblastine and DTIC in patients with metastatic melanoma. Proc Am Soc Clin Oncol 1988;7:250.
11. Madajewicz S, Karakousis C, West CR, Caracandas J, Avellanosa AM. Malignant melanoma brain metastases: review of Roswell Park Memorial Institute experience. Cancer 1984;53:2550-2552.
12. Matalka KZ, Bailey MQ, Barth RF, Staubus AE, Soloway AH, Moeschberger ML, Coderre J A, Rofstad EK. Boron neutron capture therapy of intracerebral melanoma using boronophenylalanine as a capture agent. Cancer Res 1993;53:3308-3313.
13. Mendez IM, Del Maestro RF. Cerebral metastases from malignant melanoma. Can .1 Neurol Sci 1988; 15:119-123.
14. Morse HG, Moore GE, Ortiz LM, Gonzalez R, Robinson WA. Malignant melanoma: from subcutaneous nodule to brain metastasis. Cancer Genet Cytogenet 1994;72:16-23.
15. Oredsson S, Ingvar C, Stromblad LG, Jonsson PE. Palliative surgery for brain metastases of malignant melanoma. Eur J Surg Oncol 1990;16:451-456.
16. Pimenta LHM, Benabou S, Pimenta AL. Melanoma maligno cerebral: a respeito de 15 casos. Seara Med Neurocir 1981;10:177-188.
17. Robinson WA, Mughiil Tl, Thomas MR, Johnson M, Spiegel RJ. Treatment of metastatic malignant melanoma with recombinant interferon alta 2. Immunobiology 1982;172:275-282.
18. Routh A, Khansur T, Hickman BT, Bass D. Management of brain metastases: past, present and future. Southern Med J 1994;87:1218-1226.
19. Somaza S. Kondziolka D, Lundsford LD, Kirkwood JM, Flickinger JC. Stereotatic radiosurgery for cerebral metastatic melanoma. J Neurosurg 1993;79:661-666.
20. Sperlescu A, Balbo RJ, Lofgren J. Melanomas metastáticos intracranianos. Rev Paul Med 1974;83:217-220.
21. Stevens G, Firth I, Coates A. Cerebral metastases from malignant melanoma. Radiother Oncol 1992;23:185-191.
22. Stridsklcv IC, Hagen S, Kleep O. Radiation therapy for brain metastases from malignant melanoma. Acta Radiol Oncol 1984;23:231-235.

Datas de Publicação

Publicação nesta coleção
10 Nov 2010
Data do Fascículo
Jun 1997

This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.

[1] 1. Brega K, Robinson WA, Winston K, Wittenberg W. Surgical treatment of brain metastases in malignant melanoma. Cancer 1990;66:2105-2110.

[2] 2. Choi KN, Withers R, Rotman M. Metastatic melanoma in brain: rapid treatment or large dose fractions. Cancer 1985;56:10-15.

[3] 3. Davey P, O'Brien P. Disposition of cerebral metastases from malignant melanoma: implications for radiosurgery. Neurosurgery 1991;28:8-14.

[4] 4. Dolan RA. .Successful removal of solitary metastatic cerebral malignant melanoma: case report. Surg Neurol 1993;39:466-468.

[5] 5. Fell DA, Leavens ME, McBride CM. Surgical versus nonsurgical management of metastatic melanoma of the brain. Neurosurgery 1980;7:238-242.

[6] 6. Fernandez E, Maira G. Puca A, Vignati A. Multiple intracranial metastases of malignant melanoma with long-term survival. JNeurosurg 1984;60:621-624.

[7] 7. Fletcher WS, Daniels DS, Sondak VK, Dana B, Townsend R, Hynes HE, Hutchins LF, Pancoast JR. Evaluation of cisplatin and DTIC in inoperable stage IIII and IV melanoma. Am J Clin Oncol 1993;16:359-362.

[8] 8. Hugen NA, Cirrincione C, Thaler HT, DeAngelis LM. The role of radiation therapy following resection of single brain metastasis from melanoma. Neurology 1990;40:158-160.

[9] 9. Kim MK, Warren TC, Kimball ES. Purification and characterization of a low molecular weight transforming growth factor from the urine of melanoma patients. J Biol Chem 1985:260:9237-9243.

[10] 10. Legha S, Ring S, Plager C. Evaluation of a triple-drug regimen containing cisplatin, vinblastine and DTIC in patients with metastatic melanoma. Proc Am Soc Clin Oncol 1988;7:250.

[11] 11. Madajewicz S, Karakousis C, West CR, Caracandas J, Avellanosa AM. Malignant melanoma brain metastases: review of Roswell Park Memorial Institute experience. Cancer 1984;53:2550-2552.

[12] 12. Matalka KZ, Bailey MQ, Barth RF, Staubus AE, Soloway AH, Moeschberger ML, Coderre J A, Rofstad EK. Boron neutron capture therapy of intracerebral melanoma using boronophenylalanine as a capture agent. Cancer Res 1993;53:3308-3313.

[13] 13. Mendez IM, Del Maestro RF. Cerebral metastases from malignant melanoma. Can .1 Neurol Sci 1988; 15:119-123.

[14] 14. Morse HG, Moore GE, Ortiz LM, Gonzalez R, Robinson WA. Malignant melanoma: from subcutaneous nodule to brain metastasis. Cancer Genet Cytogenet 1994;72:16-23.

[15] 15. Oredsson S, Ingvar C, Stromblad LG, Jonsson PE. Palliative surgery for brain metastases of malignant melanoma. Eur J Surg Oncol 1990;16:451-456.

[16] 16. Pimenta LHM, Benabou S, Pimenta AL. Melanoma maligno cerebral: a respeito de 15 casos. Seara Med Neurocir 1981;10:177-188.

[17] 17. Robinson WA, Mughiil Tl, Thomas MR, Johnson M, Spiegel RJ. Treatment of metastatic malignant melanoma with recombinant interferon alta 2. Immunobiology 1982;172:275-282.

[18] 18. Routh A, Khansur T, Hickman BT, Bass D. Management of brain metastases: past, present and future. Southern Med J 1994;87:1218-1226.

[19] 19. Somaza S. Kondziolka D, Lundsford LD, Kirkwood JM, Flickinger JC. Stereotatic radiosurgery for cerebral metastatic melanoma. J Neurosurg 1993;79:661-666.

[20] 20. Sperlescu A, Balbo RJ, Lofgren J. Melanomas metastáticos intracranianos. Rev Paul Med 1974;83:217-220.

[21] 21. Stevens G, Firth I, Coates A. Cerebral metastases from malignant melanoma. Radiother Oncol 1992;23:185-191.

[22] 22. Stridsklcv IC, Hagen S, Kleep O. Radiation therapy for brain metastases from malignant melanoma. Acta Radiol Oncol 1984;23:231-235.