Ultrahypofractionation in the treatment of disseminated skin melanoma patients with multiple brain metastases

Objective. To improve local treatment efficacy and reduce neurological mortality in patients with multiple intracranial melanoma metastases using extreme hypofractionation of the whole-brain irradiation dose. Material and methods. The study included 45 patients with multiple melanoma metastases to the brain. Patients were divided into 2 groups. Group 1 (study group) received treatment with WBRT with a total dose of 6.5 Gy, 3 times weekly, with a total dose of 26 Gy. Twenty-four patients were treated. Group 2 (control group) received treatment according to clinical guidelines with WBRT with a total dose of 3 Gy, daily, with a total dose of 30 Gy. Twenty-one patients were treated. Results. Median survival was not statistically significantly different: 4.500 months in the study group versus 4.017 months in the control group, p=0.3436. The immediate effectiveness of therapy is demonstrated by better local control in the study group with a decrease in the average total volume of foci (p=0.0199) from 19.8 cm3 to 10.65 cm3 (by 46.21%), the average number of foci (p=0.0481) from 18.26 to 14.95 (18.13%) during the control study after 2 months, against a decrease in the average total volume of foci from 21.83 cm3 to 20.14 cm3 (by 7.32%), the average number of foci from 38.38 to 47.92 (an increase of 19.9%) during the standard treatment regimen. Effectiveness was also noted in improving the mean prognosis on the GPA scale from 0.913 before radiation therapy to 1.421 (a 35.75% improvement) in the study group, compared to an 11% improvement from 0.7188 before radiation therapy to 0.8077 (p=0.0144). Conclusion. Further study of the investigated method is required to confirm the efficacy and safety of this fractionation regimen in the treatment of patients with multiple intracranial melanoma metastases.