National Cancer Institute®
Last Modified: February 1, 2002
UI - 11778285
AU - Li Y; Qu F; Li J
TI - [Biotherapy and biochemotherapy of patients with malignant melanoma]
SO - Zhonghua Zhong Liu Za Zhi 2000 Sep;22(5):430-1
AD - Cancer Institute (Hospital), Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing 100021, China.
OBJECTIVE: To evaluate the efficacy of postoperative biochemotherapy on survival of patients with malignant melanoma. METHODS: One hundred and five patients with malignant melanoma received postoperative biotherapy/biochemotherapy or radiotherapy/chemotherapy. The median time of follow-up was 3 years (from 1 to 5 years). RESULTS: The median survival time (MST) in the whole series of patients was 27 months (range: 2-72 months). The MST in patients received postoperative biotherapy/biochemotherapy (57 cases) was 32 months with a 3-year survival rate of 36.8%. That in patients received postoperative radiotherapy/chemotherapy (54 cases) was 20 months. CONCLUSION: Biotherapy/biochemotherapy following surgery may significantly improve survival in patients with malignant melanoma.
UI - 11789383
AU - Pierard GE; Pierard-Franchimont C; Claessens N; Arrese JE
TI - Cutaneous melanoma and the Mosan Study Group of pigmented tumors. A step forward to trace invisible skin cancers and to offer better treatments.
SO - Rev Med Liege 2001;56 Suppl():S1-6
AD - Department of Dermatopathology, CHU Sart Tilman, Liege.
UI - 11705357
AU - Bonaccorsi P; Ansel JC; Armstrong CA
TI - Management of high-risk melanoma.
SO - Dermatol Clin 2001 Oct;19(4):727-35
AD - Department of Dermatology, Emory University School of Medicine, Veterans Affairs Medical Center, Atlanta, Georgia, USA.
Improved treatment options for patients with high-risk melanoma are of great importance for clinicians who participate in the care of these patients. There remains an overall lack of response to existing treatment options, which continues to fuel the efforts of basic scientists and clinicians to pursue other approaches for the treatment of melanoma that is no longer limited to the skin. Continued investigation into the innovative and concurrent use of surgery, chemotherapy, immunotherapy, and radiation therapy holds significant promise for improved outcomes in the management of patients with this devastating disease.
UI - 11716443
AU - Sugranes G; Vidal-Sicart S; Piulachs J; Bombuy E; Pons F; Castel T; Rull
TI - R; Herranz R; Visa J Gamma-detecting probe used intraoperatively to locate the sentinel lymph node in patients with malignant melanoma.
SO - Eur J Surg 2001 Aug;167(8):581-6
AD - Department of Surgery, Nuclear Medicine, University of Barcelona, Spain.
OBJECTIVE: To assess the usefulness of lymphoscintigraphy and intraoperative gamma probe in the detection of sentinel lymph nodes. DESIGN: Prospective open study. SETTING: University hospital, Spain. SUBJECTS: 40 patients with malignant melanoma (24 stage I/II, 16 stage III). INTERVENTION: The day before operation a lymphoscintigram with 99mTc-nanocolloid was taken and the first lymph node identified was considered to be the sentinel node. A hand-held gamma probe was used for intraoperative mapping. MAIN OUTCOME MEASURE: Identification of the sentinel node. RESULTS: Sentinel nodes were identified in 39/40 patients (98%). In 24 patients with stage I/II disease, 34 sentinel nodes were found (6 invaded and 28 clear of melanoma). A total number of 161 regional lymph nodes were harvested, none of them invaded by melanoma. In 16 patients with stage III disease, 22 sentinel nodes were located (14 invaded and 8 clear of melanoma). A total of 89 regional lymph nodes were excised in patients with invaded sentinel nodes (44 of which were invaded and 45 clear of disease). 41 lymph nodes were excised from patients with clear sentinel nodes, and all were also clear of melanoma. CONCLUSIONS: We conclude that this is a useful technique for the selection of patients with melanoma who may require lymphadenectomy.
UI - 11802046
AU - Fisher SR
TI - Elective, therapeutic, and delayed lymph node dissection for malignant melanoma of the head and neck: analysis of 1444 patients from 1970 to 1998.
SO - Laryngoscope 2002 Jan;112(1):99-110
AD - Division of Otolaryngology-Head and Neck Surgery, Duke University Medical Center, Box 3805, Durham, NC 27710, U.S.A. samuel.fisher@Duke.edu
OBJECTIVE: The purpose of this article is to evaluate the effects on survival, disease-free interval, and recurrence patterns for patients undergoing elective, therapeutic, and delayed lymph node dissection for malignant melanoma of the head and neck. STUDY DESIGN AND METHODS: A retrospective computer-aided analysis was performed comparing 1444 patients treated from 1970 to 1998 at Duke University Medical Center. A total of 446 of the 1444 (32%) of patients with head and neck melanoma underwent some form of lymph node dissection. Survival, disease-free interval, and recurrence rates for patients having 1) no initial lymph node dissection (no LND), 2) elective lymph node dissection (ELND) within 2 months of date of diagnosis, 3) therapeutic lymph node dissection (TLND) for metastatic regional disease at diagnosis, or 4) delayed lymph node dissection (DLND) for patients developing regional lymph node metastasis later than 3 months from the date of diagnosis were compared. RESULTS: A total of 246 patients undergoing ELND demonstrated 11% with occult disease. DLND for regional lymph node recurrence was reported at a median time interval of 1.2 years from diagnosis. Multivariate analysis indicated a significant improvement in survival for DLND when compared with patients undergoing ELND plus sign in circle or TLND (P =.01). Distant metastasis was the site of first recurrence in 12% of patients undergoing no initial LND. Five-year survival after DLND and TLND was 56% and 36%, respectively. CONCLUSION: Patients undergoing DLND had an overall better survival than patients undergoing TLND or ELND with positive nodes. The progression of metastatic disease following regional node disease occurred in 35% to 45% of cases, underscoring the need for effective adjunctive therapy.
UI - 11561681
AU - Whitehead RP; Unger JM; Flaherty LE; Eckardt JR; Taylor SA; Didolkar MS;
TI - Samlowski W; Sondak VK Phase II trial of CI-980 in patients with disseminated malignant melanoma and no prior chemotherapy. A Southwest Oncology Group study.
SO - Invest New Drugs 2001;19(3):239-43
AD - University of Texas Medical Branch at Galveston, USA.
Malignant melanoma is increasing in frequency at a rapid rate in the United States. Metastatic disease is chemoresistant with DTIC considered the most active single agent. CI-980 is a synthetic mitotic inhibitor that blocks the assembly of tubulin and microtubules. It has shown cytotoxic activity against a broad spectrum of murine and human tumor cell tines. CI-980 can cross the blood brain barrier, is effective when given orally or parenterally, and is active against multidrug resistant cell lines overexpressing P-glycoprotein. In this trial, patients with disseminated melanoma with measurable disease, SWOG performance status of 0-1, no prior chemotherapy or immunotherapy for metastatic disease, and adequate hepatic and renal function, were enrolled. Treatment with CI-980 was given by 72 h continuous i.v. infusion at a dose of 4.5 mg/m2/day, days 1-3 every 21 days. Twenty-four patients were registered on this study with no patients ineligible. They ranged in age from 33-78 with performance status of 0 in 15 patients and 1 in 9 patients. Nineteen patients had visceral disease with 12 having liver involvement. There were no confirmed responses. The overall response rate was 0% (95% CI 0%-14%). The median overall survival is eleven months (95% CI 4-14 months). The most common toxicities were hematologic and consisted of leukopenia/granulocytopenia and anemia, with nausea/vomiting and malaise/fatigue/weakness also frequent. CI-980 administered at this dose and schedule has insufficient activity in the treatment of disseminated malignant melanoma to warrant further investigation.
UI - 11733075
AU - Gruber BM; Anuszewska EL; Skierski JS
TI - Activation of programmed cell death (apoptosis) by adriamycin in human neoplastic cells.
SO - Mutat Res 2001 Dec 12;484(1-2):87-93
AD - Department of Vitamin Drugs, Drug Institute, 30/34 Chelmska Str., 00-725, Warsaw, Poland.
We have studied the occurrence of the apoptosis phenomenon in the action of adriamycin (ADR) on human melanoma cells sensitive (ME18) and resistant (ME18/R) to ADR.The study has shown that the intensity of apoptotic morphological changes noted in melanoma cells depended on the duration of the ADR treatment.We have not observed any positive correlation between the induction of apoptosis and sensitivity to ADR.We have used a fluorescence microscope and flow cytometer to evaluate apoptotic events in cells treated with ADR.
UI - 11756950
AU - Kelley LC; Starkus L
TI - Immunohistochemical staining of lentigo maligna during Mohs micrographic surgery using MART-1.
SO - J Am Acad Dermatol 2002 Jan;46(1):78-84
AD - Department of Dermatologic Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA.
BACKGROUND: Lentigo maligna (LM) often displays extensive subclinical spread. Mohs micrographic surgery (MMS) has been proposed to help delineate the true histologic margin; however, visualizing atypical melanocytes on frozen section is challenging and often requires confirmatory permanent paraffin sections. OBJECTIVE: Our aim was to use a monoclonal antibody to rapidly stain frozen sections during MMS to facilitate better visualization of atypical melanocytes. METHODS: Frozen sections of LM during MMS were stained with MART-1 (melanoma antigen recognized by T cells) and compared with paraffin-embedded sections. RESULTS: We found 100% correlation between frozen sections stained with MART-1 and paraffin-embedded sections. CONCLUSIONS: Atypical melanocytes can be better visualized on frozen sections of LM by using MART-1 rather than hematoxylin and eosin. This allows for easier identification during MMS and better chance of complete removal of LM lesions.
UI - 11682325
AU - Retsas S
TI - Adjuvant therapy of malignant melanoma: is there a choice?
SO - Crit Rev Oncol Hematol 2001 Nov;40(2):187-93
AD - Melanoma Unit, Department of Medical Oncology, Charing Cross Hospital, Fulham Palace Road, W6 8RF, London, UK. email@example.com
The methodological differences, data interpretation and conclusions of recent studies of adjuvant therapy in high-risk malignant melanoma, are discussed in detail in this communication. Two observations emerge from this analysis:There is as yet no adjuvant treatment that has conclusively been shown to influence overall survival for high-grade primary lesions with or without clinically occult microscopic metastases in regional lymph nodes.With currently available drugs, meaningful benefit is more likely, if adjuvant treatment is administered on development of clinically apparent regional lymph nodes metastases.The paradox of adjuvant therapy being apparently more effective in more advanced stages of the disease is not unique to melanoma and has been observed in other cancers. This paradox can be explained by the notion that currently available treatments will not eradicate the last malignant phenotype. They may, however, anticipate and frustrate the clinical expression of the next episode of disease activity, in a defined period of time.
UI - 11720430
AU - Ravaud A; Delaunay M; Chevreau C; Coulon V; Debled M; Bret-Dibat C;
TI - Courbon F; Gualde N; Nguyen Bui B Granulocyte-macrophage colony-stimulating factor alone or with dacarbazine in metastatic melanoma: a randomized phase II trial.
SO - Br J Cancer 2001 Nov 16;85(10):1467-71
AD - Department of Medicine, Institut Bergonie, Regional Cancer Center, Bordeaux, France.
The potential antitumoral effect of granulocyte-macrophage colony-stimulating factor (GM-CSF) led us to evaluate GM-CSF alone or with dacarbazine (DTIC) in metastatic melanoma in first line randomized phase II. Treatment was arm A: GM-CSF: 5 microg kg(-1), bid, 14 consecutive days every 21 days and arm B: GM-CSF: 5 microg kg(-1), bid, day 2 to day 19 every 21 days and DTIC: 800 mg m(-2), day 1 of each cycle. 32 patients (pts) were included, 15 pts in arm A and 17 in arm B. All pts had visceral metastatic sites. 9 had only one metastatic site. The median number of cycles given was 2 in arm A and 3 in arm B. 100% and 89.4% of the planned dose of GM-CSF was given in arm A and arm B respectively. No objective response was obtained. 19 pts experienced at least WHO grade 3 toxicity. All pts had fever, 29 had a decrease in performance status and 23 had pain. Grade 3 toxicity were fever (38.7%), decrease in performance status (32.3%), pain (19.4%) and dyspnoea (12.5%). In this study, GM-CSF alone or in association with DTIC did not induce any antitumoral activity with subsequent toxicity.
UI - 11801787
AU - LeBoit PE
TI - Nevus, redux.
SO - Am J Dermatopathol 2001 Oct;23(5):491-3
AD - Department of Pathology, University of California, San Francisco, California 94115, USA. firstname.lastname@example.org
UI - 10458681
AU - Essner R; Conforti A; Kelley MC; Wanek L; Stern S; Glass E; Morton DL
TI - Efficacy of lymphatic mapping, sentinel lymphadenectomy, and selective complete lymph node dissection as a therapeutic procedure for early-stage melanoma.
SO - Ann Surg Oncol 1999 Jul-Aug;6(5):442-9
AD - Roy E. Coats Research Laboratories of the John Wayne Cancer Institute, Santa Monica, California 90404, USA.
BACKGROUND: Lymphatic mapping, sentinel lymphadenectomy, and selective complete lymph node dissection (LM/SL/SCLND) is an increasingly popular alternative to elective lymphadenectomy (ELND) for patients with early-stage melanoma. Although several reports have demonstrated the accuracy of the LM/SL technique, there are no data on its therapeutic value. METHODS: We performed a matched-pair statistical analysis of 534 patients with clinical stage I melanoma; one half of the patients were treated with LM/SL and the other half were treated with ELND. Patients in the two treatment groups were matched for age (54% were < or =50 years of age), gender (63% were male patients), site of the primary melanoma (49% were on the extremities, 36% on the trunk, and 15% on the head and neck), and thickness of the primary melanoma (7% were < 0.75 mm, 42% between 0.75 and 1.5 mm, 43% between 1.51 and 4.0 mm, and 8% > 4 mm). Patients in the LM/SL group underwent complete regional lymphadenectomy (SCLND) only if the LM/SL specimen contained metastatic melanoma. RESULTS: The overall incidences of nodal metastases were no different (P = .18) between LM/SL (15.7%) and ELND (12%) groups, but the incidence of occult nodal disease was significantly (P = .025) higher among patients with intermediate-thickness (1.51-4.0-mm) primary tumors who underwent LM/SL (23.7%) instead of ELND (12.2%). Survival data were compared by the log-rank score test. LM/SL/SCLND and ELND resulted in equivalent 5-year rates of disease-free survival (79 +/- 3.3% and 84 +/- 2.2%, respectively; P = .25) and overall survival (88 +/- 3.0% and 86 +/- 2.1%, respectively; P = .98). The LM/SL and ELND groups also exhibited similar incidences of same-basin recurrences (4.8% vs. 2.1%, P = .10, respectively) and in-transit metastases (2.6% vs. 3.8%, P = .48) after tumor-negative dissections. Patients who underwent ELND showed a higher incidence of distant recurrences (8.9% vs. 4.0%, P = .03), but this may be related to the longer follow-up period for these patients (median, 169 months), compared with the LM/SL-treated patients (45 months). Among patients with tumor-positive nodal dissections, the 5-year overall survival rates were higher, and approached significance (P = .077) for patients treated by LM/SL/SCLND (64 +/- 12%) compared with ELND (45 +/- 10%). CONCLUSIONS: These findings suggest that LM/SL/SCLND is therapeutically equivalent to ELND but may be more effective for identifying nodal metastases in patients with intermediate-thickness primary tumors.
UI - 10761786
AU - Balch CM; Soong S; Ross MI; Urist MM; Karakousis CP; Temple WJ; Mihm MC;
TI - Barnhill RL; Jewell WR; Wanebo HJ; Harrison R Long-term results of a multi-institutional randomized trial comparing prognostic factors and surgical results for intermediate thickness melanomas (1.0 to 4.0 mm). Intergroup Melanoma Surgical Trial.
SO - Ann Surg Oncol 2000 Mar;7(2):87-97
AD - email@example.com
BACKGROUND: Ten- to 15-year survival results were analyzed from a prospective multi-institutional randomized surgical trial that involved 740 stages I and II melanoma patients with intermediate thickness melanomas (1.0 to 4.0 mm) and compared elective (immediate) lymph node dissection (ELND) with clinical observation of the lymph nodes as well as prognostic factors that independently predict outcomes. METHODS: Eligible patients were stratified according to tumor thickness, anatomical site, and ulceration, and then prerandomized to either ELND or nodal observation. By using Cox stepwise multivariate regression analysis, the independent predictors of outcome were tumor thickness (P < .001), the presence of tumor ulceration (P < .001), trunk site (P = .003), and patient age more than 60 years (P = .01). RESULTS: Overall 10-year survival was not significantly different for patients who received ELND or nodal observation (77% vs. 73%; P = .12). Among the prospectively stratified subgroups of patients, 10-year survival rates favored those patients with ELND, with a 30% reduction in mortality rate for the 543 patients with nonulcerated melanomas (84% vs. 77%; P = .03), a 30% reduction in mortality rate for the 446 patients with tumor thickness of 1.0 to 2.0 mm (86% vs. 80%; P = .03), and a 27% reduction in mortality rate for 385 patients with limb melanomas (84% vs. 78%; P = .05). Of these subgroups, the presence or absence of ulceration should be the key factor for making treatment recommendations with regard to ELND for patients with intermediate thickness melanomas. CONCLUSIONS: These long-term survival rates from patients treated at 77 institutions demonstrate that ulceration and tumor thickness are dominant predictive factors that should be used in the staging of stages I and II melanomas, and confer a survival advantage for these subgroups of prospectively defined melanoma patients.
UI - 11827070
AU - Salomone B; Ponti R; Gasco MR; Ugazio E; Quaglino P; Osella-Abate S;
TI - Bernengo MG In vitro effects of cholesteryl butyrate solid lipid nanospheres as a butyric acid pro-drug on melanoma cells: evaluation of antiproliferative activity and apoptosis induction.
SO - Clin Exp Metastasis 2000;18(8):663-73
AD - Department of Medical and Surgical Specialties, University of Turin, Italy.
Literature data show that butyric acid derivatives bear a dose-dependent differentiative anti-proliferative activity on cancer cell lines and that apoptosis induction may play a major role. Although it was recently shown that solid lipid nanospheres (SLNs) are a suitable tool for several in vivo drug administration routes, there is little available information on melanoma cell lines. This study was aimed at evaluating the anti-proliferative and apoptotic in vitro effects of cholesteryl butyrate (chol-but) SLNs on melanoma cells. Increasing concentrations of chol-but SLNs were used to test two melanoma cell lines. Both cell lines were treated with Na-butyrate (Na-but) and chol-but SLNs for viability. Those tested with chol-but SLNs were more effective than Na-butirate (3 to 72 h). The apoptotic effects of chol-but SLNs were evaluated between 3 and 72 h by annexin-V (ANX-V)/propidium iodide (PI) staining and the antiproliferative effect by PI staining. Apoptosis anti-proliferative-regulatory proteins as bcl-2, Fas/APO1 (CD95) and PCNA (PC10) were also investigated. Flow cytometric analyses evidenced a G(0/1)-S transition block and a 'sub-G(0/1)' apoptotic peak from 0.5 to 1.0 mM butyric acid. In ANX-V/PI flow cytometric staining, a dose- and time-dependent increase in the apoptotic cell percentage (ANX-V+) coupled with a down-regulation of PC10 and bcl-2 and a parallel up-regulation of Fas/APO1 (CD95) were found in both lines started after 3 to 24 h of chol-but SLNs treatment. Results show that chol-but SLNs exerts a dose/time-dependent effect in melanoma cell apoptosis induction between 3 and 24 h and a dose but not time-dependent effect after 24 h of treatment.
UI - 11719029
AU - Kim EM; Sivanandham M; Stavropoulos CI; Bartolucci AA; Wallack MK
TI - Overview analysis of adjuvant therapies for melanoma--a special reference to results from vaccinia melanoma oncolysate adjuvant therapy trials.
SO - Surg Oncol 2001 Jul-Aug;10(1-2):53-9
AD - Department of Surgery, Saint Vincents Hospital and Medical Center/New York Medical College, 170 West 12th Street, New York, NY 10011, USA.
A phase III, randomized, double-blind, multi-institutional vaccinia melanoma oncolysate (VMO) trial was performed for patients with stage III (AJCC) melanoma. When compared with the control vaccinia virus (V) therapy, VMO therapy did not show clinical efficacy in the final analysis of data from this trial. However, the data did allude to significant therapeutic efficacy with VMO therapy if it had been compared with an observation arm. Therefore, a comparative overview statistical analysis was performed to identify the therapeutic efficacy of VMO. This review compares VMO results with data from the treatment and observation arms of other prominent randomized anti-melanoma biologic trials (i.e., ECOG EST 1684; SWOG, IFN-gamma (J. Natl. Cancer Inst. 87 (1995) 1710); WHO IFN-alfa-2a (ASCO 14 (1995) 410); Mayo IFN-alfa-2a (J. Clin. Oncol. 13 (1995) 2776); French IFN-alfa-2a (ASCO 15 (1996) 437). The analysis was carried out comparing the disease-free interval (DFI) and overall survival (OS). The analysis shows that the VMO results are fairly comparable to the results of the treatment arms from the ECOG and Mayo trials at the 5-year mark; percent DFI 0.37, 0.37, and 0.4, percent OS 0.48, 0.46, 0.47, respectively. In some cases, VMO DFI is superior to the observation arms from other studies; ECOG, Mayo, and WHO; 0.37 versus 0.26, 0.3, 0.27 (4 years), respectively. These comparative results suggest that the vaccinia arm is not a true observation arm in the VMO trial, and the VMO could have shown an enhanced efficacy had the trial included a no-treatment observation control arm.
UI - 11826486
AU - Gorbunova VA; Orel NF; Semina OV; Egorov GN; Borodkina AG; Manziuk LV
TI - [Aranoza -- a new Russian antineoplastic drug]
SO - Vopr Onkol 2001;47(6):672-5
AD - N.N. Blokhin Center for Oncology Research, Russian Academy of Medical Sciences, Moscow.
Myelosuppression is a toxicity-related limitation for aranoza dosage. The drug proved effective in the treatment of uterine sarcoma, cancer of the head and neck, breast, Hodgkin's disease and lymphosarcoma during stage II of clinical studies. Complete regression was reported in the treatment of melanoma (ca. 12%). Good results of chemoimmunotherapy should be expected in untreated patients as well as intraarterial infusions for local lesions of the extremities. Clinical trials of aranoza used in combined modalities of therapy in various sites continue.
UI - 11683284
AU - Ridolfi L; Ridolfi R; Ascari-Raccagni A; Fabbri M; Casadei S; Gatti A;
TI - Trevisan G; Righini MG Intralesional granulocyte-monocyte colony-stimulating factor followed by subcutaneous interleukin-2 in metastatic melanoma: a pilot study in elderly patients.
SO - J Eur Acad Dermatol Venereol 2001 May;15(3):218-23
AD - Istituto Oncologico Romagnolo, Italy. firstname.lastname@example.org
AIM AND BACKGROUND: Recent data in the literature indicate that antigen-presenting cells (APC) are inactive in tumour tissue because of local immunosuppression. Tumour-infiltrating lymphocyte (TIL) signal activation transducing mechanisms are also seriously impaired. Administration of granulocyte macrophage-colony stimulating factor (GM-CSF) may lead to APC recovery and interleukin (IL)-2 may restore local TIL activation. Moreover, IL-2 increases the systemic lymphocyte population, an event that seems to correlate with a better prognosis. STUDY DESIGN: The present phase I-II study was carried out to examine whether intralesional injection of GM-CSF followed by subcutaneous IL-2 would induce a clinical response in advanced, pretreated elderly melanoma patients. METHODS: Sixteen patients over 60 years of age received intralesional GM-CSF (150 ng per lesion on day 1), generally divided between the two largest cutaneous lesions, followed by perilesional subcutaneous IL-2 (3,000,000 IU) for 5 days (days 3-7 inclusive) every 3 weeks. RESULTS: Four clinical responses [two partial (PR) and two minimal (MR)] (25%), which also involved lesions that had not been directly treated, and nine cases of stable disease were observed. The response duration for PR and MR was 9, 4, 4 and 2.5 + months, respectively. Stable disease (56%) recorded in the nine patients was short-term (3-6 months). Three patients rapidly progressed after two, two and one therapy cycles, respectively. The patient who reached the best PR had a fairly high absolute lymphocyte count (1600-2400/mm3). The second one, who reached complete remission after subsequent locoregional chemotherapy and hyperthermia, however, had a low absolute lymphocyte count that had doubled by the end of treatment. Blood lymphocyte values in the other patients were too varied to allow any correlation with clinical response. Therapy was well tolerated and only mild fever was observed, with the exception of one patient who had grade 3 fever, with muscle pain and arthralgia. CONCLUSIONS: Considering the very low toxicity observed, this treatment might be indicated in elderly patients for whom systemic therapy is no longer a viable option. Improved scheduling and timing could result from further studies.
UI - 11769862
AU - Cooper JS; Chang WS; Oratz R; Shapiro RL; Roses DF
TI - Elective radiation therapy for high-risk malignant melanomas.
SO - Cancer J 2001 Nov-Dec;7(6):498-502
AD - Department of Radiation Oncology, New York University School of Medicine, New York, USA.
PURPOSE: Local-regional recurrence rates of 30%-50% have been reported after resection of high-risk malignant melanomas (multiple node involvement, extracapsular spread, deep invasion, recurrent disease, and/or microscopically involved margins). Recently, we have been offering elective radiation therapy, after definitive surgery, to selected patients who have high-risk malignant melanomas. We herein report our initial results. PATIENTS AND METHODS: From 1993 to 1999, 40 patients who underwent surgery for high-risk malignant melanomas (multiple involved lymph nodes [21 patients]; close or microscopically involved surgical margins [nine patients]; extracapsular extension [six patients]; previously resected, recurrent disease [three patients]; and/or primary tumors more than 4 mm thick [four patients]) received elective radiation therapy. Thirty-six patients received 3000 cGy in five fractions (600 cGy per fraction given twice weekly), and four patients received 3600 cGy in six fractions. RESULTS: At a median follow-up of 18.4 months (range, 3.8-74.1 months), the actuarial 5-year local-regional control rate was 84%. Systemic recurrence rates in these patients were similar to those reported for this subset of patients, and the actuarial overall survival rate at 5 years was 39%. Acute toxicity was limited to erythema of the skin and, in one instance, probable cellulitis, with no late sequelae. DISCUSSION: Elective radiation therapy (600 cGy per fraction for five or six fractions) effectively controlled residual subclinical disease after surgery; however, better adjuvant systemic therapies need to be designed to eliminate distant metastases and to alter survival rates.
UI - 11789400
AU - Reinhold U
TI - Cutaneous malignant melanoma: from early diagnosis to gene therapy.
SO - Bull Mem Acad R Med Belg 2001;156(3-4):212-6; discussion 216-8
AD - Department of Dermatology, Saarland University Hospital, Homburg, Germany.
Knowledge about diagnostic procedures in melanoma has increased rapidly within the past few years. These new techniques include epiluminescence microscopy and computerized image analysis of pigmented skin lesions, as well as the identification of single tumor cells in normal tissue, such as sentinal lymph node and peripheral blood by molecular approaches. The introduction of polymerase-chain reaction based methods can be regarded as a prototype of this dramatic development that opens up the possibility of clinical use in patients, and of influencing treatment strategies. While early melanoma is highly curable by surgical means, the prognosis of patients with metastatic disease remains poor. A flurry of new treatment strategies are currently in clinical development. These include test-directed chemotherapy, biologic therapy, vaccine therapy, as well as gene therapy. All different therapeutic strategies have to take into account immense resistance and escape mechanisms of malignant melanoma cells, that potentially limit the effectiveness of new treatment concepts.
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