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Surgeon Assessment of the Technical Impact of Neoadjuvant Systemic Therapy on Operable Stage III Melanoma

  • Melanoma
  • Published:
Annals of Surgical Oncology Aims and scope Submit manuscript

Abstract

Introduction

The effect of neoadjuvant systemic therapies (NST) on technical aspects of operation for resectable stage III melanoma is unknown. Prospective capture of the estimated and actual degree of difficulty of therapeutic lymphadenectomy at presentation and after NST may inform the relative merits of NST versus surgery followed by adjuvant therapy.

Methods

We designed surgeon survey tools to capture key impressions at baseline prior to NST and postoperatively. We conducted a sub-study within a multi-institutional clinical trial for high-risk operable stage III melanoma (NeoACTIVATE, NCT03554083) which enrolls clinically node-positive patients to 12 weeks of combinatorial NST determined by BRAF status. Survey data were analyzed.

Results

Surveys were completed for 24 of 25 patients (96%). Affected nodal basins were cervical (3, 13%) axillary (9, 38%), inguinal ± pelvic (14, 58%); 2 (8%) involved ≥ 2 basins. Baseline estimates included largest affected node size (median/range 4/1.4–11 cm), number of involved nodes (median/range 3/1–10) and tumor fixation (present in 12, 50%). At operation, actual degree of difficulty increased from the baseline estimate in 4 (17%) and decreased in 6 (25%). Surgery was less difficult, average, or more difficult versus usual operation in 4, 9, and 11 cases (17%, 38%, 46%), respectively.

Conclusions

Although many operations were judged to be more difficult than the usual therapeutic lymphadenectomy, operation following NST was more often perceived as easier than more difficult versus baseline impression. Engaging surgical oncologists to perform similar structured assessments across clinical trials will permit cross-study analysis of the effect of NSTs on the technical conduct of lymphadenectomy.

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Authors and Affiliations

  1. Department of Surgery, Division of Breast & Melanoma Surgical Oncology, Mayo Clinic, Rochester, MN, USA

    Tina J. Hieken M.D. & Mara A. Piltin D.O.

  2. Mayo Clinic Cancer Center, Mayo Clinic, Rochester, MN, USA

    Tina J. Hieken M.D., Heidi J. Turner M.S.W. & Matthew S. Block M.D., Ph.D.

  3. Department of Otorhinolaryngology, Mayo Clinic, Rochester, MN, USA

    Daniel L. Price M.D.

  4. Department of Medicine, Division of Medical Oncology, Mayo Clinic, Rochester, MN, USA

    Heidi J. Turner M.S.W. & Matthew S. Block M.D., Ph.D.

Authors
  1. Tina J. Hieken M.D.
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  2. Daniel L. Price M.D.
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  3. Mara A. Piltin D.O.
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  4. Heidi J. Turner M.S.W.
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  5. Matthew S. Block M.D., Ph.D.
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Corresponding author

Correspondence to Tina J. Hieken M.D..

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Disclosure

This work was funded by a Stand Up to Cancer Catalyst® Award supported by Genentech.

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Hieken, T.J., Price, D.L., Piltin, M.A. et al. Surgeon Assessment of the Technical Impact of Neoadjuvant Systemic Therapy on Operable Stage III Melanoma. Ann Surg Oncol 29, 780–786 (2022). https://doi.org/10.1245/s10434-021-11112-9

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  • DOI: https://doi.org/10.1245/s10434-021-11112-9

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