Melanoma

Annals of Surgical Oncology

, Volume 19, Issue 8, pp 2547-2555

First online:

Metastasectomy for Distant Metastatic Melanoma: Analysis of Data from the First Multicenter Selective Lymphadenectomy Trial (MSLT-I)

  • J. Harrison HowardAffiliated withDepartment of Surgical Oncology, John Wayne Cancer Institute at Saint John’s Health Center
  • , John F. ThompsonAffiliated withSydney Melanoma Unit, Royal Prince Alfred Hospital
  • , Nicola MozzilloAffiliated withIstituto Nazionale dei Tumori de Napoli
  • , Omgo E. NiewegAffiliated withNetherlands Cancer Institute
  • , Harald J. HoekstraAffiliated withUniversity Medical Center Groningen and Groningen University
  • , Daniel F. RosesAffiliated withNew York University School of Medicine
  • , Vernon K. SondakAffiliated withH. Lee Moffitt Cancer Center and Research Institute
  • , Douglas S. ReintgenAffiliated withUniversity of South Florida
  • , Mohammed Kashani-SabetAffiliated withCenter for Melanoma Research and Treatment, California Pacific Medical Center Research Institute
    • , Constantine P. KarakousisAffiliated withMillard Fillmore Hospital
    • , Brendon J. CoventryAffiliated withUniversity of Adelaide and Royal Adelaide Hospital
    • , William G. KraybillAffiliated withRoswell Park Cancer Institute
    • , B. Mark SmithersAffiliated withQueensland Melanoma Project, Princess Alexandra Hospital
    • , Robert ElashoffAffiliated withDepartment of Biostatistics, University of California at Los Angeles
    • , Stacey L. SternAffiliated withDepartment of Surgical Oncology, John Wayne Cancer Institute at Saint John’s Health Center
    • , Alistair J. CochranAffiliated withDepartment of Pathology and Laboratory Medicine, University of California at Los Angeles
    • , Mark B. FariesAffiliated withDepartment of Surgical Oncology, John Wayne Cancer Institute at Saint John’s Health Center
    • , Donald L. MortonAffiliated withDepartment of Surgical Oncology, John Wayne Cancer Institute at Saint John’s Health Center Email author 

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Abstract

Background

For stage IV melanoma, systemic medical therapy (SMT) is used most frequently; surgery is considered an adjunct in selected patients. We retrospectively compared survival after surgery with or without SMT versus SMT alone for melanoma patients developing distant metastases while enrolled in the first Multicenter Selective Lymphadenectomy Trial.

Methods

Patients were randomized to wide excision and sentinel node biopsy, or wide excision and nodal observation. We evaluated recurrence site, therapy (selected by treating clinician), and survival after stage IV diagnosis.

Results

Of 291 patients with complete data for stage IV recurrence, 161 (55 %) underwent surgery with or without SMT. Median survival was 15.8 versus 6.9 months, and 4-year survival was 20.8 versus 7.0 % for patients receiving surgery with or without SMT versus SMT alone (p < 0.0001; hazard ratio 0.406). Surgery with or without SMT conferred a survival advantage for patients with M1a (median > 60 months vs. 12.4 months; 4-year survival 69.3 % vs. 0; p = 0.0106), M1b (median 17.9 vs. 9.1 months; 4-year survival 24.1 vs. 14.3 %; p = 0.1143), and M1c (median 15.0 vs. 6.3 months; 4-year survival 10.5 vs. 4.6 %; p = 0.0001) disease. Patients with multiple metastases treated surgically had a survival advantage, and number of operations did not reduce survival in the 67 patients (42 %) who had multiple surgeries for distant melanoma.

Conclusions

Our findings suggest that over half of stage IV patients are candidates for resection and exhibit improved survival over patients receiving SMT alone, regardless of site and number of metastases. We have begun a multicenter randomized phase III trial comparing surgery versus SMT as initial treatment for resectable distant melanoma.