Routine screening for brain metastases in patients with metastatic melanoma: good patient care or an unnecessary burden?

melanoma MRI / magnetic resonance imaging brain metastases

dr. M. Jalving
A. Eggen

Nature of the research:
Retrospective, cohort study

Fields of study:
neurology oncology radiology

Background / introduction
More than half of the patients with metastatic melanoma develop brain metastases during the course of their disease. Brain metastases are associated with neurological symptoms and worse survival compared to patients without brain metastases. Over the last decade, the treatment options available (systemic and localized) for melanoma patients with brain metastases have expanded greatly and long-term survival can be achieved in a subset of these patients. Early identification of brain metastases increases treatment options.

Brain MRI-scans are the gold standard for the diagnosis of brain metastases. In the UMCG all patients with metastatic melanoma have routine brain MRI-scans at diagnosis of metastatic disease and every six months thereafter, when no brain metastases have been diagnosed. This approach allows brain metastases to be diagnosed and treated prior to the occurrence of neurological symptoms. However, the contribution of these routine MRI-scans to patient care remains unknown.
Research question / problem definition
Primary research question:
- How often are asymptomatic brain metastases diagnosed by routinely performed brain MRI-scans within the first 2 years after diagnosis of metastatic melanoma?

Secondary research questions:
- In what percentage of patients are brain metastases diagnosed by a routinely performed brain MRI-scan?
- How many patients have brain metastases at the time of diagnosis of metastatic melanoma?
- Does the diagnosis of (asymptomatic) brain metastases change the planned treatment strategy?
To answer the research question there is a cohort of 160 consecutive patients diagnosed with metastatic melanoma between June 2015 and June 2017 available. The first 2 years after diagnosis of metastatic melanoma will be analysed. For almost half of the patients, much of the required data has already been extracted during a similar project on the use of MRI scans in patients that have been diagnosed with brain metastases. For this group of patients, only the period between the diagnosis of metastatic melanoma and the diagnosis of brain metastases needs to be analyzed. The required databases and items to be extracted from the patient’s records have been created. Data regarding patient- and tumour characteristics, performed MRI-scans (number of- and scan indication of MRI-scan), anti-tumour treatments, date of diagnosis of brain metastases and symptoms at time of diagnosis will be extracted from the patient’s records.

As a student you can be involved in all parts of the research, collecting the data, data analyzes and working towards a paper. You can also attend the multidisciplinary melanoma tumour board meetings to become familiar with the disease management of patients with melanoma brain metastases. You will be supervised by an MD-PhD student on a daily basis and there are weekly meetings with the supervising team from medical oncology/neurology which you can join as required. Depending on a student’s personal interests there are more opportunities to engage in research within the Department of Medical Oncology.
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