The purpose of this study was to evaluate the outcome of surgical treatment of brain
metastasis in patients with metastatic
melanoma or
renal cell cancer after
interleukin-2 (IL-2)
therapy. A retrospective analysis was conducted at the Surgery Branch, National Cancer Institute. All patients with a diagnosis of metastatic
melanoma or
renal cell cancer who received
IL-2 from January 1, 1985 to January 1, 1996 (n = 1385) were screened for the development of brain
metastasis. Forty patients underwent surgical treatment of brain
metastasis that developed after initiating
IL-2 therapy. Thirty-six were rendered free of disease after resection of a single
metastasis and were the focus of this study. Twenty-two of the 36 patients achieved a clinical response (10 complete responses and 12 partial responses) at extracranial sites of disease after IL-2-based
immunotherapy and before the development of brain
metastasis. The median disease-free interval in the brain after resection of a single
metastasis was 21, 7, and 3 months for patients achieving a complete response, partial response, and no response (CR, PR, and NR) to
IL-2 therapy, respectively. The median survival after
craniotomy for these three groups of patients was 23, 17, and 7 months, respectively. The disease-free interval in the brain and the overall survival after
craniotomy were significantly longer for patients achieving a CR to previous
immunotherapy when compared with patients achieving a PR or NR. Of the 10 patients who had achieved a prior CR, 8 remained disease free in the brain at last follow-up, 6 remained alive beyond 1 year, and 3 > 4 years. Twenty-five patients experienced
neurologic symptoms before
craniotomy and all had complete resolution of their symptoms after surgery. Surgical treatment of single brain
metastasis in patients with metastatic
melanoma or
renal cell cancer is indicated in carefully selected patients. The benefits of resection include palliation of symptoms and the potential for a prolonged disease-free interval in the brain.