Gutman Haim, Ben-Ami Eytan, Shapira-Frommer Roni, Schachter Jacob
Department of Surgery, Rabin Medical Center, Beilinson Campus, Israel.
Oncol Lett. 2012 Aug;4(2):307-310. doi: 10.3892/ol.2012.712. Epub 2012 May 11.
Patients with potentially resectable advanced stage III and IV melanoma are a selected subgroup that gain maximal advantage if treated in a melanoma center. Surgery combined with chemo/chemobiotherapy may yield durable remission and long-term palliation. Thirty-seven non-randomly selected patients underwent systemic therapy with the aim of consolidating treatment by surgery. Data were collected prospectively, and analyzed retrospectively. The median follow-up from diagnosis was 50 (3-307) months and 15 (1-156) months when calculated from the last intervention. Twenty-two males and 15 females, with a median age at diagnosis of 44 (20-71) years, with 13 trunk, 13 extremity, 3 head and neck and 8 unknown primary melanomas were included. There were 17 stage III and 20 stage IV patients with a median Breslow thickness of 3.7 (0.45-26) mm. Chemo/chemobiotherapy achieved 7 clinical complete responses (cCRs), 28 partial responses (PRs) and 2 instances of stable disease. Six of the 7 cCRs were operated on, securing pathological complete response in 5 and PR in one. Four of these five and the PR patient still have no evidence of disease (NED). Twenty-one of 30 PR patients were rendered NED by surgery; 14 of these 21 patients succumbed to melanoma, and one is alive with stable disease. Overall, 11 of 37 patients have not succumbed to melanoma, with a median of 72 (14-156) months survival following the last intervention. Of the eight patients with unknown primary melanomas, five have not succumbed to melanoma, with a median of 89 (30-156) months survival following the last intervention. Patients with marginally resectable stage III and IV melanoma have a significant 30% chance, according to this series, for durable remission if treated by a multidisciplinary team in a melanoma center using induction chemobiotherapy and surgery. Results are more favorable for patients with an unknown primary lesion. In view of the currently approved new effective treatments for melanoma, this study may be considered a proof-of-principle investigation, enabling long-term remissions by combining induction therapy and surgery.
具有潜在可切除的晚期III期和IV期黑色素瘤患者是一个特定的亚组，如果在黑色素瘤中心接受治疗，他们将获得最大益处。手术联合化疗/化学生物疗法可能产生持久缓解和长期姑息效果。37例非随机选择的患者接受了全身治疗，目的是通过手术巩固治疗。数据前瞻性收集，并进行回顾性分析。从诊断开始的中位随访时间为50（3 - 307）个月，从最后一次干预计算为15（1 - 156）个月。纳入22例男性和15例女性，诊断时的中位年龄为44（20 - 71）岁，其中13例为躯干、13例为四肢、3例为头颈部黑色素瘤，8例为原发灶不明的黑色素瘤。有17例III期和20例IV期患者，中位Breslow厚度为3.7（0.45 - 26）mm。化疗/化学生物疗法获得7例临床完全缓解（cCR）、28例部分缓解（PR）和2例病情稳定。7例cCR患者中有6例接受了手术，5例获得病理完全缓解，1例为PR。这5例中的4例以及PR患者仍无疾病证据（NED）。30例PR患者中有21例通过手术达到NED；这21例患者中有14例死于黑色素瘤，1例存活且病情稳定。总体而言，37例患者中有11例未死于黑色素瘤，最后一次干预后的中位生存期为72（14 - 156）个月。8例原发灶不明的黑色素瘤患者中有5例未死于黑色素瘤，最后一次干预后的中位生存期为89（30 - 156）个月。根据本系列研究，边缘可切除的III期和IV期黑色素瘤患者如果在黑色素瘤中心由多学科团队采用诱导化学生物疗法和手术治疗，有30%的显著机会实现持久缓解。对于原发灶不明的患者，结果更有利。鉴于目前已批准的黑色素瘤新有效治疗方法，本研究可被视为一项原理验证研究，通过联合诱导治疗和手术实现长期缓解。
