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.
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Acknowledgment
This study was supported by grant P01 CA29605 from the National Cancer Institute, and by funding from the Melanoma Research Alliance (Washington, DC), Dr. Miriam & Sheldon G. Adelson Medical Research Foundation (Boston, MA), Lincy Foundation (Beverly Hills, CA), Amyx Foundation, Inc. (Boise, ID), Alan and Brenda Borstein (Los Angeles, CA), Mr. and Mrs. Louis Johnson (Stanfield, AZ), Heather and Jim Murren (Las Vegas, NV), and the Wayne and Gladys Valley Foundation (Oakland, CA). Dr. Howard is the Harold McAlister Charitable Foundation Fellow. Content is solely the responsibility of the authors and does not necessarily represent the official view of the National Cancer Institute or the National Institutes of Health.
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This study is conducted on behalf of the Multicenter Selective Lymphadenectomy Trial (MSLT) Group.
Members of the Multicenter Selective Lymphadenectomy Trial (MSLT) Group are listed in Appendix.
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10434_2012_2398_MOESM1_ESM.pdf
Figure 5 (supplement). Phase III trial of surgery ┬▒ postoperative adjuvant BCG immunotherapy versus best medical therapy as initial treatment for resectable stage IV melanoma (NIH Clinical Trials Identifier: NCT01013623). (PDF 17 kb)
Appendix: Multicenter Selective Lymphadenectomy Trial Group
Appendix: Multicenter Selective Lymphadenectomy Trial Group
We are grateful for the support and assistance of all members of the Multicenter Selective Lymphadenectomy Trial Group:
Independent data and safety monitoring committee—J. Kirkwood (chair), J. Daly, M. Kutner, M. Mihm, G. Smith, M. Urist, N. Beegun (patient advocate); Trial sites and principal investigators—Sydney Melanoma Unit, Sydney, Australia: J. F. Thompson; Istituto Nazionale dei Tumori de Napoli, Naples, Italy: N. Mozzillo; Netherlands Cancer Institute, Amsterdam: O. E. Nieweg; New York University, New York: D. F. Roses; University Medical Center Groningen and University of Groningen, Groningen, the Netherlands: H. J. Hoekstra; Millard Fillmore Hospital, Buffalo, NY: C. P. Karakousis; H. Lee Moffit Cancer Center, Tampa, FL: D. S. Reintgen; University of California and Mt. Zion Medical Center, San Francisco: S. P. Leong; Royal Adelaide Hospital, Adelaide, Australia: B. J. Coventry; Roswell Park Cancer Institute, Buffalo, NY: W. Kraybill; Princess Alexandra Hospital, Brisbane, Australia: M. Smithers; Henry Ford Hospital, Detroit: S. D. Nathanson; University of Texas Southwestern Medical Center at Dallas, Dallas: J. F. Huth; University of Hawaii at Manoa, Honolulu: J. H. Wong; University of Pennsylvania, Philadelphia: D. L. Fraker; Tom Baker Cancer Centre, Calgary, AB, Canada: W. Temple; City Hospital of Nürnberg, Nürnberg, Germany: E. Paul; John Wayne Cancer Institute at Saint John’s Health Center, Santa Monica, CA: D. L. Morton.
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Howard, J.H., Thompson, J.F., Mozzillo, N. et al. Metastasectomy for Distant Metastatic Melanoma: Analysis of Data from the First Multicenter Selective Lymphadenectomy Trial (MSLT-I). Ann Surg Oncol 19, 2547–2555 (2012). https://doi.org/10.1245/s10434-012-2398-z
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DOI: https://doi.org/10.1245/s10434-012-2398-z