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Surgery and adjuvant therapies in the treatment of stage IV melanoma: our experience in 84 patients

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Abstract

Background and aims

Survival rates of patients with stage IV melanoma are poor: Median survival is 7–8 months and 5-year survival rates about 5%. There is no agreement on the role of surgery at this stage. Most patients with metastatic melanoma are not able to undergo resection and usually are sent to systemic chemo- and immunotherapy.

Patients and methods

Eighty-four patients operated on for stage IV melanoma were evaluated. Of them, 61.9% were submitted to reiterative surgery with 168 operations and 182 surgical procedures overall. A total of 90.5% was submitted to adjuvant therapies according to aggressive and reiterated schedules: chemotherapy, immunotherapy, dendritic cells vaccine, infusion of tumor infiltrating lymphocytes, local therapies as electrochemotherapy.

Results

The mean overall survival (Kaplan–Meier) was 56.7 months (1 year: 72.1%, 3 years: 46.5%, 5 years: 23.16%). The survival of reiterative surgery was significatively longer than single surgery (62.7 vs 42.4 months, median 50.9 vs 16.0), p = 0.03. Multivariated Cox analysis was performed for disease-free interval, repeated surgery, adjuvant therapies, and site of metastasis according to the American Joint Committee on Cancer: Reiterative surgery was shown as an independent prognostic factor (p < 0.05).

Conclusion

Metastatic resection associated with adjuvant therapy may improve overall survival and, in some instances, can provide long-term survival, whatever site and numbers of metastasis. In our series, reiterative surgery was more significatively efficient in improving survival than single-time surgery.

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Authors and Affiliations

  1. Institute of Clinical Surgery, University of Trieste, Trieste, Italy

    Francesca Tauceri & Mauro Roseano

  2. Division of Surgery and Advanced Cancer Therapies, Morgagni Hospital, Forlì, Italy

    Gianni Mura, Massimo Framarini & Giorgio M. Verdecchia

  3. Division of Oncology, Morgagni Hospital, Forlì, Italy

    Laura Ridolfi

  4. Via del Molino a vento, 68, 34137, Trieste, Italy

    Francesca Tauceri

Authors
  1. Francesca Tauceri
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  2. Gianni Mura
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  3. Mauro Roseano
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  4. Massimo Framarini
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  5. Laura Ridolfi
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  6. Giorgio M. Verdecchia
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Correspondence to Francesca Tauceri.

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Tauceri, F., Mura, G., Roseano, M. et al. Surgery and adjuvant therapies in the treatment of stage IV melanoma: our experience in 84 patients. Langenbecks Arch Surg 394, 1079–1084 (2009). https://doi.org/10.1007/s00423-008-0312-8

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  • DOI: https://doi.org/10.1007/s00423-008-0312-8

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