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Brain Metastases From Melanoma: Is There a Role for Concurrent Temozolomide in Addition to Whole Brain Radiation Therapy?

Schild, Steven E. MD*; Behl, Deepti MD†; Markovic, Svetomir N. MD†; Brown, Paul D. MD*; Sande, Jonathan R. MD‡; Deming, Richard L. MD§; Rowland, Kendrith M. Jr. MD¶; Bearden, James D. MD∥

American Journal of Clinical Oncology: December 2010 - Volume 33 - Issue 6 - pp 633-636
doi: 10.1097/COC.0b013e3181c4c54b
Original Article: Central Nervous System

Objectives: This study was performed to evaluate the addition of temozolomide (TMZ) to whole brain radiotherapy (WBRT) for brain metastases from melanoma.

Methods: Seven patients with brain metastases from melanoma were treated on a North Central Cancer Treatment Group (NCCTG) trial (N0274) of TMZ plus WBRT. TMZ was given orally in doses of 200 mg/m2 for 5 days every 4 weeks for up to 8 cycles. WBRT was started on the first day of TMZ and included the delivery of 3750 cGy in 15 fractions. In addition, separately analyzed was a cohort of 53 patients treated at the Mayo Clinic who received WBRT alone (39 patients) or WBRT plus TMZ (14 patients).

Results: The median survival of the 7 patients treated on N0274 was 3.6 months with 2 of 7 (29%) failing in brain and 5 of 7 (71%) failing elsewhere. For the other cohort of 53 patients, the median survival was 3.8 months with WBRT alone compared 4.3 months for WBRT plus TMZ (P = 0.5).

Conclusions: Patients did not appear to benefit from the addition of TMZ to WBRT for the treatment of their brain metastases. Further improvements in outcome will require research to discover more effective systemic therapy and RT techniques.

From the *Department of Radiation Oncology, Mayo Clinic, Scottsdale, AZ; †Department of Medical Oncology, Mayo Clinic Rochester, Rochester, MN; ‡Duluth CCOP, Duluth, MN; §Iowa Oncology Research Association CCOP, Des Moines, IA; ¶Carle Cancer Center CCOP, Urbana, IL; and ∥Upstate Carolina CCOP, Spartanburg, SC.

N0274 was conducted as a collaborative trial of the North Central Cancer Treatment Group and Mayo Clinic and was supported in part by Public Health Service grants CA-25224, CA-37404, CA-35269, CA-35101, CA-35195, CA-35119 from the National Cancer Institute, Department of Health and Human Services. The content is solely of the authors and does not necessarily represent the official views of the National Cancer Institute or the National Institute of Health.

None of the authors has any conflicts of interest in the preparation of this manuscript.

Reprints: Steven E. Schild, MD, Department of Radiation Oncology, Mayo Clinic, 13400 E. Shea Blvd. Scottsdale, AZ 85259. E-mail: sschild@mayo.edu.

© 2010 Lippincott Williams & Wilkins, Inc.