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Type: Journal article
Title: Metastasectomy for distant metastatic melanoma: analysis of data from the First Multicenter Selective Lymphadenectomy Trial (MSLT-I)
Author: Howard, J.
Thompson, J.
Mozzillo, N.
Nieweg, O.
Hoekstra, H.
Roses, D.
Sondak, V.
Reintgen, D.
Kashani-Sabet, M.
Karakousis, C.
Coventry, B.
Kraybill, W.
Smithers, B.
Elashoff, R.
Stern, S.
Cochran, A.
Faries, M.
Morton, D.
Citation: Annals of Surgical Oncology, 2012; 19(8):2547-2555
Publisher: Lippincott Williams & Wilkins
Issue Date: 2012
ISSN: 1068-9265
Statement of
J. Harrison Howard, John F. Thompson, Nicola Mozzillo, Omgo E. Nieweg, Harald J. Hoekstra, Daniel F. Roses, Vernon K. Sondak, Douglas S. Reintgen, Mohammed Kashani-Sabet, Constantine P. Karakousis, Brendon J. Coventry, William G. Kraybill, B. Mark Smithers, Robert Elashoff, Stacey L. Stern, Alistair J. Cochran, Mark B. Faries and Donald L. Morton
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.
Keywords: Humans
Skin Neoplasms
Lymphatic Metastasis
Neoplasm Recurrence, Local
Neoplasm Staging
Lymph Node Excision
Survival Rate
Retrospective Studies
Follow-Up Studies
Middle Aged
Rights: © Society of Surgical Oncology 2012
DOI: 10.1245/s10434-012-2398-z
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Surgery publications

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