Determinants of outcome in melanoma patients with cerebral metastases.

PURPOSE: To analyze prognostic factors, effects of treatment, and survival for patients with cerebral metastases from melanoma. PATIENTS AND METHODS: All melanoma patients with cerebral metastases treated at the Sydney Melanoma Unit between 1952 and 2000 were identified. From 1985 to 2000, patients were diagnosed and treated using consistent modern techniques and this cohort was analyzed in detail. Multivariate analysis of prognostic factors for survival was performed. RESULTS: A total of 1137 patients with cerebral metastases were identified; 686 were treated between 1985 and 2000. For these 686 patients, the median time from primary diagnosis to cerebral metastasis was 3.1 years (range, 0 to 41 years). A total of 646 patients (94%) have died as a result of melanoma. The median survival from the time of diagnosis of cerebral metastasis was 4.1 months (range, 0 to 17.2 years). Treatment was as follows: surgery and postoperative radiotherapy, 158 patients; surgery alone, 47 patients; radiotherapy alone, 236 patients; and supportive care alone, 210 patients. Median survival according to treatment received for these four groups was 8.9, 8.7, 3.4, and 2.1 months, respectively; the differences between surgery and nonsurgery groups were statistically significant. On multivariate analysis, significant factors associated with improved survival were surgical treatment (P <.0001), no concurrent extracerebral metastases (P <.0001), younger age (P =.0007), and longer disease-free interval (P =.036). Prognostic factors analysis confirmed the important influence of patient selection on treatment received. CONCLUSION: This large series documents the characteristics of patients who developed cerebral metastases from melanoma. Median survival was dependent on treatment, which in turn was dependent on patient selection.

Medullary thyroid cancer: the role of radiotherapy in local control.

Fifty-one patients were treated with radiotherapy for loco-regional medullary thyroid cancer between 1960-1992. The actuarial overall survival at 5, 10 and 20 years was 69%, 52% and 30%, respectively. Patients were classified according to clinical stage (node-positive or -negative), post-operative histological residual disease status (none, microscopic or macroscopic) and dose of radiotherapy received. By univariate analysis, loco-regional recurrence-free survival was significantly longer for node-negative patients (P = 0.03). Patients who received at least 60 Gy over 6 weeks showed a trend towards improved local control (P = 0.23). The only significant variable by multivariate analysis for local recurrence-free survival was post-operative residual disease status (P=0.0005). The local control rate at 5 years was 100% for patients with no residual disease, 65% for those with microscopic tumour, and 24% for those with macroscopic residual disease. We conclude that there is a valuable role for radiotherapy in the management of patients with residual microscopic or macroscopic disease following surgery, as well as in those with inoperable disease.

Chylous ascites in Kaposi's sarcoma: a case report.

We report a case of a patient with Kaposi's sarcoma (KS), massive chylous ascites and chylous pleural effusions. This association has not been reported previously. The pathogenesis of chylous effusions is discussed with respect to KS.