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FC11 Does systemic treatment prior to completion lymph node dissection influence surgical outcomes in stage III melanoma patients?

Kounalakis, N.; Gonzalez, R.; Becker, M.A.; Lewis, K.D.; Christenson, A.; Pearlman, N.; Robinson, W.; McCarter, M.

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doi: 10.1097/01.cmr.0000382813.52699.b3
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Introduction Stage III melanoma patients have an overall 5 year survival of 24–67% [1]. For this heterogeneous group of patients, completion lymph node dissection and adjuvant therapy is recommended. The type and the timing of systemic therapy remain unclear. At University of Colorado Cancer Center, biochemotherapy is offered for stage III melanoma patients prior to and then following completion lymph node dissection. The aim of this study was to analyze the safety and efficacy of this treatment algorithm, and report its influence on surgical outcomes.

Methods Clinical and pathological information was extracted from a retrospective database on stage III melanoma patients treated from 1998-present. Eligible patients had tissue and radiological confirmation of stage III disease and administration of 2 cycles of biochemotherapy prior to and then following completion lymph node dissection. Patients were analyzed for toxicities, delays in treatment, surgical complications and survival. Statistical analysis was performed by Fisher's exact test and a Student's t test.

Results One hundred and nineteen patients were available for analysis. The mean age was 43, BMI 28, and 25% of patients had a significant medical comorbidity. Average depth of tumor was 2.5 mm, and the mean positive node count and total nodal count from the lymph node dissections were 1.5 and 20. Mean time of drain use was 19 days and 25% of all patients experienced a surgical complication. Disease free survival and overall survival were 77% and 95% at median 2.5 years follow up (range 30 days to 10 yrs). Mean time between initiation of neoadjuvant biochemotherapy to lymph node dissection was 48 days and then between lymph node dissection to the resumption of biochemotherapy was 32 days. Fifty nine patients experienced a significant toxicity and/or a delay in treatment. Drain use was significantly prolonged in the major toxicity group (22 vs 16 days, P=0.004). Disease free survival, overall survival, comorbidities, BMI, and surgical complications were similar amongst groups.

Conclusion Our data suggests that aggressive systemic treatment prior to completion lymph node dissection does not increase expected surgical complications. Despite treatment toxicities and delays, interval systemic therapy can be delivered with acceptable surgical outcomes, disease free and overall survival.

© 2010 Lippincott Williams & Wilkins, Inc.