Surgical resection for bulky or recurrent axillary metastatic melanoma

Shada, Amber L.; Walters, Dustin M.; Tierney, Samantha; Slingluff, Craig L.

doi:10.1002/jso.22058

Cited by 10 publications

(3 citation statements)

References 25 publications

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“…The rate of postoperative complications in those who proceeded to regional dissection following radiotherapy needs consideration. However, the rate of postoperative complications is similar to other contemporary series for bulky disease [19]. This has been documented previously in other disease sites using a similar treatment approach [11].…”

Section: Discussionsupporting

confidence: 84%

An innovative approach for locally advanced stage III cutaneous melanoma

Foote¹,

Burmeister²,

Dwyer³

et al. 2012

Melanoma Research

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Patients with advanced nodal melanoma are typically managed with a regional nodal dissection; however, they have a high rate of distant relapse after surgery. This study assesses the role of preoperative radiotherapy to assist with the regional control in this subset of patients. Patients who had histologically confirmed stage III malignant melanoma and were treated with preoperative radiotherapy between 2004 and 2011 were eligible. All patients were staged with computer tomography and most with [F]-fluorodeoxyglucose (FDG) PET. Patients received preoperative radiotherapy, followed by a planned regional dissection at 12-14 weeks from completion with assessment of clinical, radiological and pathological responses. The primary outcome measure was the 1-year actuarial in-field control. There were 12 patients, with nine having disease of the axilla. All patients received radiotherapy up to a median dose of 48 Gy in 20 fractions, with seven patients achieving a partial clinical response. Ten patients proceeded to surgery, with four patients developing minor wound complications. The FDG-PET response did not appear to correlate with the pathological response. The 1-year in-field control rate was 92% (95% confidence interval 54-99) and the 1-year relapse-free survival was 54% (95% confidence interval 21-78). For selected patients with high-volume regional disease, we have successfully used preoperative radiotherapy, followed by a nodal dissection. Whether this type of protocol is of value in a more general group of patients with high-volume regional disease is currently under investigation.

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Section: Discussionsupporting

confidence: 84%

An innovative approach for locally advanced stage III cutaneous melanoma

Foote¹,

Burmeister²,

Dwyer³

et al. 2012

Melanoma Research

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“…Local treatment including transarterial chemoembolization (TACE), percutaneous ethanol injection (PEI), radiotherapy, and radiofrequency ablation provides survival rates of 42–42.5% at 1 year and a median survival of 11.1–13.6 months [ 9 – 13 ]. Patients with isolated extrahepatic metastasis and preserved liver function may generally benefit from a surgical resection [ 1 , 7 ].…”

Section: Introductionmentioning

confidence: 99%

Adrenal Metastasis of Hepatocellular Carcinoma in Patients following Liver Resection or Liver Transplantation: Experience from a Tertiary Referral Center

Teegen

Mogl

Pratschke

et al. 2018

International Journal of Surgical Oncology

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Introduction Adrenal metastasis of hepatocellular carcinoma (HCC) is a rare entity and can be treated by resection, local ablative therapy, or systemic therapy. Unfortunately, data about treatment outcome, especially in liver transplant recipients, are rare. Patients and Methods From 2005 to 2015, 990 liver resections and 303 liver transplantations because of HCC were performed at our clinic. We retrospectively analyzed treatment outcome of the patients with metachronous adrenal metastasis of HCC, who received either resection, local ablation, or surveillance only. Results 10 patients were identified (0.8%). 7 patients received liver transplantation for primary HCC therapy, 3 liver resection, and 1 a local ablative therapy. 8 patients underwent adrenalectomy (one via retroperitoneoscopy), one was treated with local ablation, and one had surveillance only. Seven out of eight patients had no surgical complications and one experienced a pancreatic fistula, treated conservatively. 37.5% of the resected patients had recurrence 1 year after adrenalectomy and 75% after 2 years. The mean survival time after primary diagnosis of HCC was 96.6±22.4 months. After adrenalectomy, the mean survival time was 112.4±25.2 months. The mean time until tumor recurrence was 13.2±3.8 in the total cohort and 15.8±3.8 months in patients after adrenalectomy. The estimated overall survival after adrenalectomy was 77.2±17.4 months. Conclusion Metachronous adrenal metastasis occured in less than 1% of HCC patients. Adrenalectomy is a safe procedure and leads to acceptable survival rates even after liver transplantion. Therefore, it should be performed whenever the primary tumor is well controlled and the patient is in adequate physical condition.

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“…Impaired lymphatic drainage as a result of, for example, LN resection has been shown to compromise the transport of inflammatory cells and soluble mediators [ 3 , 39 , 40 ] and the resolution of certain inflammatory diseases [ 40 – 42 ]. Notably, secondary lymphedema, local inflammation and delayed wound healing have been reported in melanoma, breast and cervical cancer patients after lymphadenectomy [ 43 – 45 ]. Thus, the early removal of TDLNs in our cancer model may be sufficient to create local inflammation that stimulates the proliferation and survival of tumor cells, as well as angiogenesis which may also contribute to tumor growth.…”

Section: Discussionmentioning

confidence: 99%

Lymphadenectomy promotes tumor growth and cancer cell dissemination in the spontaneous RET mouse model of human uveal melanoma

Khoo

Tham

et al. 2015

Oncotarget

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Resection of infiltrated tumor-draining lymph nodes (TDLNs) is a standard practice for the treatment of several cancers including breast cancer and melanoma. However, many randomized prospective trials have failed to show convincing clinical benefits associated with LN removal and the role of TDLNs in cancer dissemination is poorly understood. Here, we found in a well-characterized spontaneous mouse model of uveal melanoma that the growth of the primary tumor was accompanied by increased lymphangiogenesis and cancer cell colonization in the LNs draining the eyes. But, unexpectedly, early resection of the TDLNs increased the growth of the primary tumor and associated blood vessels as well as promoted cancer cell survival and dissemination. These effects were accompanied by increased tumor cell proliferation and expression of phosphorylated AKT. Topical application of a broad anti-inflammatory agent, Tobradex, or an oral treatment with cyclooxygenase-2 specific inhibitor, Celecoxib, reversed tumor progression observed after complete lymphadenectomy. Our study confirms the importance of tumor homeostasis in cancer progression by showing the enhancing effects of TDLN removal on tumor growth and cancer cell dissemination, and suggests that TDLN resection may only be beneficial if used in combination with anti-inflammatory drugs such as Tobradex and Celecoxib.

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Surgical resection for bulky or recurrent axillary metastatic melanoma

Cited by 10 publications

References 25 publications

An innovative approach for locally advanced stage III cutaneous melanoma

An innovative approach for locally advanced stage III cutaneous melanoma

Adrenal Metastasis of Hepatocellular Carcinoma in Patients following Liver Resection or Liver Transplantation: Experience from a Tertiary Referral Center

Lymphadenectomy promotes tumor growth and cancer cell dissemination in the spontaneous RET mouse model of human uveal melanoma

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