Tina J Hieken1,2, Daniel L Price3, Mara A Piltin4, Heidi J Turner5,6, Matthew S Block5,6. 1. Department of Surgery, Division of Breast & Melanoma Surgical Oncology, Mayo Clinic, Rochester, MN, USA. hieken.tina@mayo.edu. 2. Mayo Clinic Cancer Center, Mayo Clinic, Rochester, MN, USA. hieken.tina@mayo.edu. 3. Department of Otorhinolaryngology, Mayo Clinic, Rochester, MN, USA. 4. Department of Surgery, Division of Breast & Melanoma Surgical Oncology, Mayo Clinic, Rochester, MN, USA. 5. Mayo Clinic Cancer Center, Mayo Clinic, Rochester, MN, USA. 6. Department of Medicine, Division of Medical Oncology, Mayo Clinic, Rochester, MN, USA.
Abstract
INTRODUCTION: The effect of neoadjuvant systemic therapies (NST) on technical aspects of operation for resectable stage III melanoma is unknown. Prospective capture of the estimated and actual degree of difficulty of therapeutic lymphadenectomy at presentation and after NST may inform the relative merits of NST versus surgery followed by adjuvant therapy. METHODS: We designed surgeon survey tools to capture key impressions at baseline prior to NST and postoperatively. We conducted a sub-study within a multi-institutional clinical trial for high-risk operable stage III melanoma (NeoACTIVATE, NCT03554083) which enrolls clinically node-positive patients to 12 weeks of combinatorial NST determined by BRAF status. Survey data were analyzed. RESULTS: Surveys were completed for 24 of 25 patients (96%). Affected nodal basins were cervical (3, 13%) axillary (9, 38%), inguinal ± pelvic (14, 58%); 2 (8%) involved ≥ 2 basins. Baseline estimates included largest affected node size (median/range 4/1.4-11 cm), number of involved nodes (median/range 3/1-10) and tumor fixation (present in 12, 50%). At operation, actual degree of difficulty increased from the baseline estimate in 4 (17%) and decreased in 6 (25%). Surgery was less difficult, average, or more difficult versus usual operation in 4, 9, and 11 cases (17%, 38%, 46%), respectively. CONCLUSIONS: Although many operations were judged to be more difficult than the usual therapeutic lymphadenectomy, operation following NST was more often perceived as easier than more difficult versus baseline impression. Engaging surgical oncologists to perform similar structured assessments across clinical trials will permit cross-study analysis of the effect of NSTs on the technical conduct of lymphadenectomy.
INTRODUCTION: The effect of neoadjuvant systemic therapies (NST) on technical aspects of operation for resectable stage III melanoma is unknown. Prospective capture of the estimated and actual degree of difficulty of therapeutic lymphadenectomy at presentation and after NST may inform the relative merits of NST versus surgery followed by adjuvant therapy. METHODS: We designed surgeon survey tools to capture key impressions at baseline prior to NST and postoperatively. We conducted a sub-study within a multi-institutional clinical trial for high-risk operable stage III melanoma (NeoACTIVATE, NCT03554083) which enrolls clinically node-positive patients to 12 weeks of combinatorial NST determined by BRAF status. Survey data were analyzed. RESULTS: Surveys were completed for 24 of 25 patients (96%). Affected nodal basins were cervical (3, 13%) axillary (9, 38%), inguinal ± pelvic (14, 58%); 2 (8%) involved ≥ 2 basins. Baseline estimates included largest affected node size (median/range 4/1.4-11 cm), number of involved nodes (median/range 3/1-10) and tumor fixation (present in 12, 50%). At operation, actual degree of difficulty increased from the baseline estimate in 4 (17%) and decreased in 6 (25%). Surgery was less difficult, average, or more difficult versus usual operation in 4, 9, and 11 cases (17%, 38%, 46%), respectively. CONCLUSIONS: Although many operations were judged to be more difficult than the usual therapeutic lymphadenectomy, operation following NST was more often perceived as easier than more difficult versus baseline impression. Engaging surgical oncologists to perform similar structured assessments across clinical trials will permit cross-study analysis of the effect of NSTs on the technical conduct of lymphadenectomy.
Authors: Alexander C J van Akkooi; Tina J Hieken; Elizabeth M Burton; Andrew J Spillane; Merrick I Ross; Charlotte Ariyan; Paolo A Ascierto; Salvatore V M A Asero; Christian U Blank; Matthew S Block; Genevieve M Boland; Corrado Caraco; Sydney Chng; B Scott Davidson; Joao Pedreira Duprat Neto; Mark B Faries; Jeffrey E Gershenwald; Dirk J Grunhagen; David E Gyorki; Dale Han; Andrew J Hayes; Winan J van Houdt; Giorgos C Karakousis; Willem M C Klop; Georgina V Long; Michael C Lowe; Alexander M Menzies; Roger Olofsson Bagge; Thomas E Pennington; Piotr Rutkowski; Robyn P M Saw; Richard A Scolyer; Kerwin F Shannon; Vernon K Sondak; Hussein Tawbi; Alessandro A E Testori; Mike T Tetzlaff; John F Thompson; Jonathan S Zager; Charlotte L Zuur; Jennifer A Wargo Journal: Ann Surg Oncol Date: 2022-01-28 Impact factor: 5.344