Recent results in cancer research. Fortschritte der Krebsforschung. Progrès dans les recherches sur le cancer
-
Recent Results Cancer Res. · Jan 2000
ReviewAdjuvant therapy of malignant melanoma and the role of sentinel node mapping.
Controversy still exists about standard management of a primary melanoma. Over the last decades randomized phase III trials have addressed questions about the width of margin in relation to the Breslow thickness of the primary lesion, the role of prophylactic isolated limb perfusion, and the role of elective lymph node dissection. Overall these trials have demonstrated that less extensive surgery is as good as more extensive surgery. Wide excision margins, prophylactic isolated limb perfusions, or the elective lymph node dissection did not improve overall survival significantly in any of the phase III trials conducted. ⋯ Thus we now have a procedure by which the melanoma stage I-II population can be dissected in a group at truly high risk for recurrence and a group with truly low risk of recurrence. The high risk group with a greater than 75% chance for systemic disease can then be selected for trial participation of various systemic adjuvant therapy regimens that may be allowed to be toxic, considering the very high risk for relapse in these patients. The node negative group of patients can be selected for participation in trials evaluating systemic adjuvant treatment of low toxicity considering the low chance for distant metastatic disease.
-
The postoperative mortality after esophagectomy still remains a major factor influencing the prognosis of esophageal cancer and largely depends on the patient's preoperative physiological status. A composite scoring system was developed to predict the risk of esophagectomy, based on quantitative assessment of preoperatively available physiological parameters. The scoring system was reviewed retrospectively on operated patients and evaluated prospectively in two subsequent patient groups. ⋯ Including this composite score into the process of patient selection and choice of procedure resulted in a decrease of postoperative mortality from 9.4% (52/553) to 1.2% (4/323) (p = 0.001). The risk of death after esophagectomy for esophageal cancer can be objectively assessed prior to surgery and quantified by a composite risk score. This score provides a useful tool in refining the criteria of patient selection for resection and choice of procedure, and markedly reduces postoperative mortality when applied prospectively.