TY - JOUR
T1 - Management of melanoma brain metastases
T2 - evidence-based clinical practice guidelines by Cancer Council Australia
AU - Hong, Angela M.
AU - Waldstein, Cora
AU - Shivalingam, Brindha
AU - Carlino, Matteo S.
AU - Atkinson, Victoria
AU - Kefford, Richard F.
AU - McArthur, Grant A.
AU - Menzies, Alexander M.
AU - Thompson, John F.
AU - Long, Georgina V.
PY - 2021/1/1
Y1 - 2021/1/1
N2 - Introduction: The brain is a common site of metastatic disease for patients with advanced melanoma. Brain metastasis portends a poor prognosis, often causing deterioration in neurological function and quality of life, and leading to neurological death. Treatment approaches including surgery, radiotherapy and systemic therapy can lead to better control of this problem. Therefore, appropriate guidelines for the management of melanoma brain metastases need to be established, with regular updating when new treatment options become available. Methods: A multidisciplinary working party established by Cancer Council Australia has produced up-to-date, evidence-based clinical practice guidelines for the management of melanoma. After selecting key clinical questions, a comprehensive literature search for relevant studies was conducted, followed by systematic review of those studies. Data were summarised and the evidence was assessed, leading to the development of recommendations. Main recommendations: Symptomatic lesions are best treated with surgery, when possible; this provides safe and effective local control. For patients with single or a small number of asymptomatic brain metastases, stereotactic radiotherapy is recommended, but in asymptomatic patients who have not previously received systemic treatment, drug therapy can be considered as a first-line treatment option. Whole brain radiotherapy may provide palliative benefits in patients with multiple brain metastases. Whenever possible, melanoma patients with brain metastases should be managed by a multidisciplinary team of melanoma specialists that considers the optimal combination and sequencing of surgery, radiotherapy and systemic therapy.
AB - Introduction: The brain is a common site of metastatic disease for patients with advanced melanoma. Brain metastasis portends a poor prognosis, often causing deterioration in neurological function and quality of life, and leading to neurological death. Treatment approaches including surgery, radiotherapy and systemic therapy can lead to better control of this problem. Therefore, appropriate guidelines for the management of melanoma brain metastases need to be established, with regular updating when new treatment options become available. Methods: A multidisciplinary working party established by Cancer Council Australia has produced up-to-date, evidence-based clinical practice guidelines for the management of melanoma. After selecting key clinical questions, a comprehensive literature search for relevant studies was conducted, followed by systematic review of those studies. Data were summarised and the evidence was assessed, leading to the development of recommendations. Main recommendations: Symptomatic lesions are best treated with surgery, when possible; this provides safe and effective local control. For patients with single or a small number of asymptomatic brain metastases, stereotactic radiotherapy is recommended, but in asymptomatic patients who have not previously received systemic treatment, drug therapy can be considered as a first-line treatment option. Whole brain radiotherapy may provide palliative benefits in patients with multiple brain metastases. Whenever possible, melanoma patients with brain metastases should be managed by a multidisciplinary team of melanoma specialists that considers the optimal combination and sequencing of surgery, radiotherapy and systemic therapy.
KW - Guidelines
KW - Melanoma brain metastasis
KW - Radiation therapy
KW - Surgery
KW - Systemic therapy
UR - http://www.scopus.com/inward/record.url?scp=85096022896&partnerID=8YFLogxK
U2 - 10.1016/j.ejca.2020.10.013
DO - 10.1016/j.ejca.2020.10.013
M3 - Article
C2 - 33207293
AN - SCOPUS:85096022896
SN - 0959-8049
VL - 142
SP - 10
EP - 17
JO - European Journal of Cancer
JF - European Journal of Cancer
ER -