Danielle K. DePalo, MD
Surgical Oncology Research Fellow
Moffitt Cancer Center, United States
Disclosure: I do not have any relevant financial / non-financial relationships with any proprietary interests.
With a rising prevalence of advanced melanoma, more patients are under surveillance including patients with resected, regionally metastatic (Stage III) disease who remain at high risk of recurrence. The increasing practice of nodal basin observation and adjuvant systemic treatment may result in different recurrence patterns than previously observed. The purpose of this systematic review was to examine the timing and patterns of recurrence for patients with regionally metastatic melanoma based on nodal management and receipt of adjuvant therapy.
Methods:
We identified randomized controlled trials and non-randomized studies published between 2010 and 2020 that reported timing and/or patterns of recurrence. We evaluated recurrence-free survival, location of recurrence, and surveillance strategy based on receipt of adjuvant systemic therapy and nodal management with observation versus completion dissection.
Results:
Among the nineteen publications that were included in our search, there was wide variation with respect to imaging surveillance intervals and imaging modality. All patients in adjuvant studies underwent completion dissection. A minority of nodal observation patients received adjuvant treatment but no study separately reported patterns of disease recurrence for this group. Patterns of disease recurrence did not differ between adjuvant and placebo/observation groups. Across all groups (adjuvant, placebo, and nodal observation), distant and multi-site recurrences exceeded locoregional recurrences (Figure 1). Eleven studies reported recurrence-free survival which ranged from 28.6% to 78.9% in the adjuvant groups to 33% to 62.6% in the placebo groups at varying timepoints.
Conclusions:
We found that adjuvant treatment improved recurrence-free survival but did not alter the patterns of disease recurrence compared to patients managed without adjuvant systemic treatment. With multiple combinatorial management strategies for resected stage III melanoma, future studies should separately report sites of disease recurrence based on adjuvant systemic treatment and nodal management to better advise patients about their risk of recurrence with each strategy.