Artikel
The value of resection of symptomatic metastases from malignant melanoma in the spotlight of molecular treatment – a retrospective analysis
Der Wert der Resektion symptomatischer Metastasen von malignen Melanomen aus dem Blickfeld der molekularen Therapien – eine retrospektive Analyse
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Veröffentlicht: | 26. Juni 2020 |
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Gliederung
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Objective: Prognosis for patients with metastatic melanoma has substantially changed due to novel medical and radiosurgical approaches. In this context, a cerebral metastectomy is rarely performed compared to other tumor entities, but is still indicated in large and/or symptomatic tumors or tumor associated hemorrhages. We evaluated the oncological course of patients after resection of symptomatic MBM in the context of the novel systemic treatment regimens.
Methods: We retrospectively evaluated patients with MBM undergoing resection of at least one metastasis. Post-surgical survival was calculated using Kaplan-Meier-estimates. Prognostic factors for survival were identified using the log-rank test and Cox proportional hazards analysis.
Results: Seventy-one patients (singular/solitary metastasis: 45.1%, 2-4 metastasis: 39.4%, > four metastasis: 15.5%) were included. Almost all patients were neurologically impaired by the metastasis. Surgery improved neurological status in these patients (median Karnofsky Performance Score (KPS) 70% pre- and 90% postoperatively). The frequency of adjuvant systemic therapy correlated with postoperative KPS (Pearson’s r 0.304, p=0.01). Median survival (OS) and local control (LC) after surgery were significantly influenced by any postoperative systemic therapy (OS: 5.2 (95%CI 3.9-6.1) vs. 22.1 (95%CI 10.6-33.4) months; p<0.0001, 6- and 12-months LC: 51 vs. 89% and 36 vs. 87%; p=0.028); the number of metastases was not decisive (p=0.528).
Conclusion: In patients with an impaired clinical status caused by MBM, metastectomy may improve the clinical status and thus facilitate further systemic therapy, which in turn increases survival.