Surgical treatment of brain metastases in malignant melanoma

Article Abstract:

The incidence of malignant melanoma is doubling every decade, and some have estimated that by the year 2000 the disease will affect 1 in 150 among the white population. Another disturbing feature of malignant melanoma is the predilection of this skin cancer to spread to the brain; roughly 75 percent of all patients with metastatic disease will have brain tumors, and 50 percent of all patients will die of brain metastases. So far, no therapy has been successful in preventing or treating these metastatic tumors in the brain. Although the surgical removal of such brain tumors does not provide a cure, a review of 13 patients with metastatic malignant melanoma in the brain revealed that surgery may prolong survival at a minimal cost in terms of illness or disability, or death from the surgical procedure itself. A total of 19 craniotomies were performed on the 13 patients, and eight patients had more than one metastatic tumor removed in a single operation. Nevertheless, there were no fatalities associated with the surgery, and none of the patients experienced neurological deficits as a result of the surgery. Seven patients died at an average of 10 months after the surgery. The longest surviving patient was alive for more than 25 months at the time of this report. In contrast, the average survival of untreated patients with metastatic malignant melanoma to the brain is about one month. As the incidence of malignant melanoma rises, greater numbers of metastatic brain tumors may be expected. Although continued research towards a potentially curative treatment is needed, substantial improvements in survival may be obtained by surgical excision of the tumor in many cases. (Consumer Summary produced by Reliance Medical Information, Inc.)

Care and treatment, Surgery, Cancer metastasis, Brain cancer

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Final report of the French Multicenter Phase II Study of the Nitrosourea Fotemustine in 153 evaluable patients with disseminated malignant melanoma including patients with cerebral metastases

Article Abstract:

The effectiveness of nitrosourea fotemustine in treating malignant melanoma, which is an aggressive tumor of melanocytes, pigmented skin cells, was assessed in 169 afflicted patients. The cancer was disseminated throughout the body, including the brain. Nitrosourea fotemustine was given in a dose of 100 milligrams per square meter of body area by intravenous infusion over a one-hour period, every week for three weeks. This was followed by a rest period of four to five weeks. Therapy was maintained at the same dose every three weeks in patients who responded or were stabilized by initial treatment, until their disease progressed. Of 169 patients treated, 153 were assessed for complete response, as indicated by the elimination of the tumor. Treatment with nitrosourea fotemustine resulted in complete responses in three cases and partial responses in 34 patients, thereby producing a response rate of 24.2 percent. The response rates at specific sites were 25 percent within the brain; 19.2 percent in the viscera (or abdominal region); and 31.8 percent at nonvisceral sites. In most cases, the duration of response was 22 weeks, and the response rate in previously untreated patients was 30.7 percent. The main toxic effects of nitrosourea fotemustine were blood-related, and included leukopenia (an abnormal decrease in white blood cells) and thrombocytopenia (an abnormal decrease in platelets, cells involved in blood clotting). These findings suggest that nitrosourea fotemustine is effective and relatively safe in treating disseminated malignant melanoma. (Consumer Summary produced by Reliance Medical Information, Inc.)

Physiological aspects, Drug therapy, Chemotherapy

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Cardiac metastases

Article Abstract:

Metastatic spread of cancer to the heart is not common, but it may complicate the course of treatment. To estimate the relative frequency of cardiac metastases, autopsy material from 1,029 patients with a total of 1,095 independent malignant tumors was examined. Of these, 110 involved metastases to the heart. The most common source of metastases to the heart were the lungs, bronchi, and pleura; these sites represented 37.3 percent of the metastases. Adenocarcinomas were the type of cancer that most often spread to the heart, and represented 36.4 percent of the cases. Within the heart itself, the epicardium, or serous pericardium on the outside of the heart, was the most common target; epicardial metastases were found in 75 percent of the cases with heart involvement. The heart muscle itself was involved in 38 percent of the cases. The incidence of metastases to the heart arising from lung cancer seems to be increasing, and the incidence from leukemias and most lymphomas seems to be decreasing, presumably due to improvements in chemotherapy. However, the incidence of metastases to the heart due to AIDS (acquired immunodeficiency syndrome), such as high-grade lymphomas and Kaposi's sarcoma, is increasing. (Consumer Summary produced by Reliance Medical Information, Inc.)

Statistics, Cancer, Thoracic cancer

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