Forum for Science, Industry and Business

Sponsored by:     3M 
Search our Site:

 

Surgical treatment for metastatic melanoma of the liver increases overall survival

01.07.2014

New Journal of the American College of Surgeons study reports that surgical treatment increases survival for metastatic melanoma patients whose disease is limited to the liver and—when combined with systemic therapy—holds promise for more patients to do well.

Surgical resection markedly improves survival among metastatic melanoma patients whose disease is isolated to a few areas in the liver, according to new study findings published in the July issue of the Journal of the American College of Surgeons. These results mark a departure for melanoma, an aggressive form of skin cancer, that is most often considered fatal once it has spread to the liver and then, not amenable to surgical treatment.

In the past, surgical treatment for liver metastases was not considered an option for most patients, as the disease typically spreads to other organs. However, advances in surgical techniques along with new systemic therapies have made existing therapies more effective and opened the door to new therapeutic approaches. 

“Although there has been a great deal of excitement about the new medical therapies, which are clearly enormous advances, those are still not the answers for everyone,” said lead investigator Mark Faries, MD, FACS, Director of the Donald L. Morton, MD, Melanoma Research Program at John Wayne Cancer Institute in Santa Monica, Calif. “We’ve been proponents of metastasectomy for a long time and wanted to know how our patients who had been treated surgically for liver metastases had done.”

... more about:
»liver »melanoma »metastases »metastatic

For the study, Dr. Faries and colleagues studied medical records of 1,078 patients who had been treated for melanoma liver metastases at their center since 1991. Of those, 58 were treated surgically with liver resection, an operation that removes the cancerous portion of the liver. In some cases, surgical treatment included local ablation therapy in addition to resection. Ablative treatments such as radiofrequency ablation or microwave ablation are used to destroy tumors in patients who are not able to have all of their metastases surgically resected.

Median overall survival among patients who underwent surgical resection was more than triple that of patients who received medical therapy without surgical treatment (24.8 months vs. 8 months). The five-year survival rate for surgical patients was 30 percent, compared with 6.6 percent for the nonsurgical group.

“What we have seen in previous studies is that many patients who are able to undergo resection of their metastatic disease from melanoma can have good long-term outcomes, which is important to remember even in an era of more effective medications,” Dr. Faries explained.

Median overall survival was similar among patients undergoing ablation (with or without resection) compared with those undergoing surgical treatment alone. The promising news is that newer technologies such as ablation may enable more metastatic melanoma patients to have surgical treatment, according to Dr. Faries.

The investigators also looked at the relationship between systemic therapy and surgical treatment. According to study authors, when patients had had their metastatic disease stabilized with systemic therapy—meaning their metastatic disease either shrank or stopped growing significantly as a result of medical therapy—and then underwent a surgical treatment, the patients whose disease had been stabilized prior to the operation did much better over the long term than those who did not have their metastatic disease stabilized.

“The presence of more effective medications may, in fact, make surgical treatment more important or may lead to new approaches that combine liver resection with these more effective medications, which may result in even better outcomes than any individual therapy alone,” Dr. Faries said.

He thinks that what holds promise for the future is the potential to combine systemic therapy with local surgical or ablative therapies. For instance, patients would undergo systemic therapy for a defined period of time and then undergo resection. “This approach could apply to liver metastases as well as metastases in other places in the body,” he said. “That path would give surgeons the opportunity to more appropriately select patients for surgical treatment and to assess their response to the new drugs.”

Study limitations include the fact that the investigation was a retrospective study spanning two decades, which means researchers were unable to control for certain factors. Additionally, since isolated liver metastases are rare in melanoma, the vast majority of the metastatic melanoma population would not be candidates for surgical resection.

“In our recent study, the fraction of patients that was able to undergo resection was higher than it had been in previous studies,” Dr. Faries said. “It is only about 1 in 20 patients that ended up being able to have the operation, but that number is still higher than it used to be.”

The bottom line, according to Dr. Faries, is that surgeons should discuss surgical resection for the treatment of melanoma liver metastases with their patients if their disease is limited to a few areas in the liver, their overall health status is good, and the disease is indolent or the patients are responding to systemic therapy.

Other study authors include Anna Leung, MD; Donald L. Morton, MD; Danielle Hari, MD; Ji-Hey Lee, PhD; Myung-shin Sim, PhD; and Anton J. Bilchik, MD, PhD, FACS.

This study was supported by grant P01CA29605 from the National Cancer Institute, Dr Miriam & Sheldon G Adelson Medical Research Foundation (Boston, MA), Borstein Family Foundation (Los Angeles, CA), The California Oncology Research Institute (Los Angeles, CA), and the John Wayne Cancer Institute Auxiliary (Santa Monica, CA). Dr. Leung was the Harold McAlister Charitable Foundation Fellow (Los Angeles, CA). Dr. Hari was the William Randolph Hearst Foundation Fellow (San Francisco, CA).  Content is solely the responsibility of the authors and does not necessarily represent the official view of the National Cancer Institute or the National Institutes of Health.

Citation: Journal of the American College of Surgeons, July 2014: Vol. 219 (1) 62-68.

# # #

About the American College of Surgeons
The American College of Surgeons is a scientific and educational organization of surgeons that was founded in 1913 to raise the standards of surgical practice and improve the quality of care for surgical patients. The College is dedicated to the ethical and competent practice of surgery. Its achievements have significantly influenced the course of scientific surgery in America and have established it as an important advocate for all surgical patients. The College has more than 79,000 members and is the largest organization of surgeons in the world. For more information, visit www.facs.org.

News from the Journal of the American College of Surgeons (JACS)

News from the College

Sally Garneski | Eurek Alert!

Further reports about: liver melanoma metastases metastatic

More articles from Health and Medicine:

nachricht The end of pneumonia? New vaccine offers hope
23.10.2017 | University at Buffalo

nachricht Scientists track ovarian cancers to site of origin: Fallopian tubes
23.10.2017 | Johns Hopkins Medicine

All articles from Health and Medicine >>>

The most recent press releases about innovation >>>

Die letzten 5 Focus-News des innovations-reports im Überblick:

Im Focus: Salmonella as a tumour medication

HZI researchers developed a bacterial strain that can be used in cancer therapy

Salmonellae are dangerous pathogens that enter the body via contaminated food and can cause severe infections. But these bacteria are also known to target...

Im Focus: Neutron star merger directly observed for the first time

University of Maryland researchers contribute to historic detection of gravitational waves and light created by event

On August 17, 2017, at 12:41:04 UTC, scientists made the first direct observation of a merger between two neutron stars--the dense, collapsed cores that remain...

Im Focus: Breaking: the first light from two neutron stars merging

Seven new papers describe the first-ever detection of light from a gravitational wave source. The event, caused by two neutron stars colliding and merging together, was dubbed GW170817 because it sent ripples through space-time that reached Earth on 2017 August 17. Around the world, hundreds of excited astronomers mobilized quickly and were able to observe the event using numerous telescopes, providing a wealth of new data.

Previous detections of gravitational waves have all involved the merger of two black holes, a feat that won the 2017 Nobel Prize in Physics earlier this month....

Im Focus: Smart sensors for efficient processes

Material defects in end products can quickly result in failures in many areas of industry, and have a massive impact on the safe use of their products. This is why, in the field of quality assurance, intelligent, nondestructive sensor systems play a key role. They allow testing components and parts in a rapid and cost-efficient manner without destroying the actual product or changing its surface. Experts from the Fraunhofer IZFP in Saarbrücken will be presenting two exhibits at the Blechexpo in Stuttgart from 7–10 November 2017 that allow fast, reliable, and automated characterization of materials and detection of defects (Hall 5, Booth 5306).

When quality testing uses time-consuming destructive test methods, it can result in enormous costs due to damaging or destroying the products. And given that...

Im Focus: Cold molecules on collision course

Using a new cooling technique MPQ scientists succeed at observing collisions in a dense beam of cold and slow dipolar molecules.

How do chemical reactions proceed at extremely low temperatures? The answer requires the investigation of molecular samples that are cold, dense, and slow at...

All Focus news of the innovation-report >>>

Anzeige

Anzeige

Event News

3rd Symposium on Driving Simulation

23.10.2017 | Event News

ASEAN Member States discuss the future role of renewable energy

17.10.2017 | Event News

World Health Summit 2017: International experts set the course for the future of Global Health

10.10.2017 | Event News

 
Latest News

Microfluidics probe 'cholesterol' of the oil industry

23.10.2017 | Life Sciences

Gamma rays will reach beyond the limits of light

23.10.2017 | Physics and Astronomy

The end of pneumonia? New vaccine offers hope

23.10.2017 | Health and Medicine

VideoLinks
B2B-VideoLinks
More VideoLinks >>>