Surgical treatment for metastatic melanoma of the liver increases overall survival

Surgical resection markedly improves survival among patients with metastatic melanoma whose disease is isolated to a few areas in the liver, according to new study findings. 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, California. "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."

For the study, published in the Journal of the American College of Surgeons (2014; doi:10.1016/j.jamcollsurg.2014.04.008), 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 5-year survival rate for surgical patients was 30%, compared with 6.6% 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," 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 Faries.

The bottom line, according to 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.

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