Skip to main content
Key Specialties
Cardiology Diabetology Endocrinology Gastroenterology Geriatrics and Gerontology Gynecology and Obstetrics Hematology Infectious Disease Internal Medicine Nephrology Neurology Oncology Pediatrics Respiratory Medicine Rheumatology Surgery
Congress Coverage
2024 ACC Congress 2023 ESMO Congress 2023 EASD Congress 2023 ERS Congress 2023 ESC Congress 2023 EHA Congress 2023 ASCO Annual Meeting
Clinical Collections
Advances in Alzheimer’s

Keynote webinar | Spotlight on sleep in brain health

LIVE: Thursday 2nd May 2024, 18:00-19:30 (CEST)

Quality sleep is essential for health. But what happens to our brains when sleep patterns are disturbed? Join our experts to explore the interplay between sleep disruption and neurological diseases, and the questions that you need to be asking your patients to help you prevent the harmful effects of sleep deprivation.
ADVANCED SEARCH
Log in
Top
Annals of Surgical Oncology
Published in: Annals of Surgical Oncology 4/2017

Open Access 01-04-2017 | Melanomas

Routine Computer Tomography Imaging for the Detection of Recurrences in High-Risk Melanoma Patients

Authors: Tristen S. Park, MD, Giao Q. Phan, MD, James C. Yang, MD, Udai Kammula, MD, Marybeth S. Hughes, MD, Kasia Trebska-McGowan, MD, Kathleen E. Morton, BS, RN, Donald E. White, BS, Steven A. Rosenberg, MD, PhD, Richard M. Sherry, MD

Published in: Annals of Surgical Oncology | Issue 4/2017

Login to get access

Abstract

Background

The use of routine CT imaging for surveillance in asymptomatic patients with cutaneous melanoma is controversial. We report our experience using a surveillance strategy that included CT imaging for a cohort of patients with high-risk melanoma.

Methods

A total of 466 patients with high-risk cutaneous melanoma enrolled in adjuvant immunotherapy trials were followed for tumor progression by physical examination, labs, and CT imaging as defined by protocol. Evaluations were obtained at least every 6 months for year 1, every 6 months for year 2, and then annually for the remainder of the 5-year study. Time to tumor progression, sites of recurrence, and the method of relapse detection were identified.

Results

The patient cohort consisted of 115 stage II patients, 328 stage III patients, and 23 patients with resected stage IV melanoma. The medium time to progression for the 225 patients who developed tumor progression was 7 months. Tumor progression was detected by patients, physician examination or routine labs, or by CT imaging alone in 27, 14, and 59% of cases respectively. Melanoma recurrences were noted to be locoregional in 36% of cases and systemic in 64% of cases. Thirty percent of patients with locoregional relapse and 75% of patients with systemic relapse were detected solely by CT imaging.

Conclusions

CT imaging alone detected the majority of sites of disease progression in our patients with high-risk cutaneous melanoma. This disease was not heralded by symptoms, physical examination, or blood work. Although the benefit of the early detection of advanced melanoma is unknown, this experience is relevant because of the rapid development and availability of potentially curative immunotherapies.
Literature
1.
NCCN guideline insights: melanoma, version 3.2016. JNCCN, 2016.
2.
Houghton A, et al. NCCN melanoma practice guidelines. Natl Compr Cancer Netw. Oncology (Williston Park), 1998;12(7A):153–77.
3.
Balch CM, et al. Final version of the American Joint Committee on Cancer staging system for cutaneous melanoma. J Clin Oncol. 2001;19(16):3635–48.CrossRefPubMed
4.
Rosenberg SA, Sherry RM, Morton KE, Scharfman WJ, Yang JC, Topalian SL, Royal RE, Kammula U, Restifo NP, Hughes MS, Schwartzentruber D, Berman DM, Schwarz SL, Ngo LT, Mavroukakis SA, White DE, Steinberg SM. Tumor progression can occur despite the induction of very high levels of self/tumor antigen-specific CD8+ T cells in patients with melanoma. J Immunol. 2005;175(9):6169–76.CrossRefPubMed
5.
Rosenberg SA, Sherry RM, Morton KE, Yang JC, Topalian SL, Royal RE, Kammula US, Restifo NP, Hughes MS, Schwarz SL, Ngo LT, Mavroukakis SA, White DE. Altered CD8(+) T-cell responses when immunizing with multiepitope peptide vaccines. J Immunother. 2006;29(2):224–31.CrossRefPubMedPubMedCentral
6.
Rosenberg SA, Yang JC, Kammula US, Hughes MS, Restifo NP, Schwarz SL, Morton KE, Laurencot CM, Sherry RM. Different adjuvanticity of incomplete Freund’s adjuvant derived from beef or vegetable components in melanoma patients immunized with a peptide vaccine. J Immunother. 2010;33(6):626–9.CrossRefPubMedPubMedCentral
7.
Romano E, et al. Site and timing of first relapse in stage III melanoma patients: implications for follow-up guidelines. J Clin Oncol. 2010;28(18):3042–7.CrossRefPubMedPubMedCentral
8.
Meyers MO, et al. Method of detection of initial recurrence of stage II/III cutaneous melanoma: analysis of the utility of follow-up staging. Ann Surg Oncol. 2009;16(4):941–7.CrossRefPubMed
9.
Francken AB, et al. Detection of first relapse in cutaneous melanoma patients: implications for the formulation of evidence-based follow-up guidelines. Ann Surg Oncol. 2007;14(6):1924–33.CrossRefPubMed
10.
Garbe C, et al. Prospective evaluation of a follow-up schedule in cutaneous melanoma patients: recommendations for an effective follow-up strategy. J Clin Oncol. 2003;21(3):520–9.CrossRefPubMed
11.
Poo-Hwu WJ, et al. Follow-up recommendations for patients with American Joint Committee on Cancer Stages I-III malignant melanoma. Cancer. 1999;86(11):2252–8.CrossRefPubMed
12.
Hofmann U, et al. Primary staging and follow-up in melanoma patients–monocenter evaluation of methods, costs and patient survival. Br J Cancer. 2002;87(2):151–7.CrossRefPubMedPubMedCentral
13.
Brown RE, et al. Surveillance after surgical treatment of melanoma: futility of routine chest radiography. Surgery. 2010;148(4):711–6; discussion 716–7.
14.
Eggermont, Alexander MM, et al. Adjuvant ipilimumab versus placebo after complete resection of high-risk stage III melanoma (EORTC 18071): a randomised, double-blind, phase 3 trial. Lancet Oncol. 2015;16.5:522–30.
15.
16.
17.
Atkinds MB, Kunkel L, Sznol M, Rosenberg SA. High-dose recombinant interleukin-2 therapy in patients with metastatic melanoma: long-term survival update. Cancer J Sci Am. 2000;6:S11.
18.
Larkin J, et al. Combined Nivolumab and ipilimumab or monotherapy in untreated melanoma. N Engl J Med. 2015;2015(373):23–34.
19.
Prieto PA, et al. CTLA-4 blockade with ipilimumab: long-term follow-up of 177 patients with metastatic melanoma. Clin Cancer Res. 2012;18(7):2039–47.CrossRefPubMedPubMedCentral
20.
Rosenberg SA, Yang JC, Sherry RM, et al. Durable complete responses in heavily pretreated patients with metastatic melanoma. Clin Cancer Res. 2011;17(13):4550–7.CrossRefPubMedPubMedCentral
21.
Goff SL, Dudley ME, Citrin DE, et al. Randomized, prospective evaluation comparing intensity of lymphodepletion before adoptive transfer of tumor-infiltrating lymphocytes for patients with metastatic melanoma. J Clin Oncol. 2016;34(20):2389–97.CrossRefPubMed
Metadata
Title
Routine Computer Tomography Imaging for the Detection of Recurrences in High-Risk Melanoma Patients
Authors
Tristen S. Park, MD
Giao Q. Phan, MD
James C. Yang, MD
Udai Kammula, MD
Marybeth S. Hughes, MD
Kasia Trebska-McGowan, MD
Kathleen E. Morton, BS, RN
Donald E. White, BS
Steven A. Rosenberg, MD, PhD
Richard M. Sherry, MD
Publication date
01-04-2017
Publisher
Springer International Publishing
Published in
Annals of Surgical Oncology / Issue 4/2017
Print ISSN: 1068-9265
Electronic ISSN: 1534-4681
DOI
https://doi.org/10.1245/s10434-017-5768-8

Other articles of this Issue 4/2017

Annals of Surgical Oncology 4/2017 Go to the issue

Breast Oncology

Chemotherapy Significantly Improves Survival for Patients with T1c-T2N0M0 Medullary Breast Cancer: 3739 Cases From the National Cancer Data Base

Hepatobiliary Tumors

Impact of Skeletal Muscle Mass, Muscle Quality, and Visceral Adiposity on Outcomes Following Resection of Intrahepatic Cholangiocarcinoma

Hepatobiliary Tumors

Total Laparoscopic Reversal ALPPS

Pancreatic Tumors

Survival Analysis and Risk for Progression of Intraductal Papillary Mucinous Neoplasia of the Pancreas (IPMN) Under Surveillance: A Single-Institution Experience

Gastrointestinal Oncology

Reliable Surgical Techniques for Lymphadenectomy Along the Left Recurrent Laryngeal Nerve During Thoracoscopic Esophagectomy in the Prone Position

Gastrointestinal Oncology

How Do We Bridge the West and the East in the Treatment for Gastric Cancer?