Surgical management of melanoma: an EORTC Melanoma Group survey
Identifieur interne : 000147 ( France/Analysis ); précédent : 000146; suivant : 000148Surgical management of melanoma: an EORTC Melanoma Group survey
Auteurs : A. Testori [Italie] ; J. Soteldo [Venezuela] ; B. Powell [Royaume-Uni] ; F. Sales [Belgique] ; L. Borgognoni [Italie] ; P. Rutkowski [Pologne] ; F. Lejeune [Suisse] ; Pam Van Leeuwen [Suisse] ; A. Eggermont [Pays-Bas, France]Source :
- ecancermedicalscience [ 1754-6605 ] ; 2013.
Abstract
The objective of the article is to explore the surgical practices and views in the treatment of melanoma within members and non-members of the EORTC Melanoma Group (MG) during the years 2003–2005.
An e-mail questionnaire (see
A total of 75 questionnaires were returned from centres in Europe (70), Israel (3), Australia (1) and the United States (1). Resection margins on primary melanoma vary according to AJCC 2002 staging. Sixty three of 75 MUs perform Sentinel node biopsy. Modified radical neck dissection is performed in 82% of MUs for macrometastases and in 80% of MUs for micrometastases. Most MUs surveyed perform all three levels of Berg axillary dissection whether for macrometastases (79%) or micrometastases (62%). An ilio inguinal-obturator dissection is proposed with macrometastases (41% of MUs), whereas 33% of MUs perform a pelvic dissection only if the Cloquet node is positive. Twenty five of 75 MUs perform an isolated limb perfusion with a therapeutic indication; three also as an adjuvant. The majority of MUs perform surgery for distant metastases including superficial (53 of 75 [71%]) or solitary visceral metastases (52 of 75[69%]) or for palliation (58 of 75[77%]).
The adequacy of surgery appears to be the most important milestone in the therapeutic approach of melanoma. Even if surgery is fundamental in the different stages of the disease, there is quite a variability concerning the extension of the surgical treatment related to primary and lymphnodal disease. Phase III randomised trials have shown that wide margins, elective lymph node dissections, and prophylactic isolated limb perfusions have not improved survival and cannot be considered the standard of care in the routine management of primary melanoma. The surgical subgroup of the EORTC Melanoma Group is developing a new version of the surgical survey questionnaire including new treatment modalities like isolated limb infusion and electrochemotherapy, which were not frequently in use some years ago, to obtain new data to be compared to the nearly ten-year-old data.
Url:
DOI: 10.3332/ecancer.2013.294
PubMed: 23589724
PubMed Central: 3622410
Affiliations:
- Belgique, France, Italie, Pays-Bas, Pologne, Royaume-Uni, Suisse, Venezuela
- Région de Bruxelles-Capitale
- Bruxelles
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PMC:3622410Le document en format XML
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Annunziata, Italy</nlm:aff><country xml:lang="fr">Italie</country><wicri:regionArea> Centro Regionale di Riferimento per il Melanoma, Ospedale S. M. Annunziata</wicri:regionArea><wicri:noRegion>Ospedale S. M. Annunziata</wicri:noRegion></affiliation></author><author><name sortKey="Rutkowski, P" sort="Rutkowski, P" uniqKey="Rutkowski P" first="P" last="Rutkowski">P. Rutkowski</name><affiliation wicri:level="1"><nlm:aff id="aff6"> Centrum Onkologii Instytut im Marii, Sklodowskiej-Curie Warsawa, Poland</nlm:aff><country xml:lang="fr">Pologne</country><wicri:regionArea> Centrum Onkologii Instytut im Marii, Sklodowskiej-Curie Warsawa</wicri:regionArea><wicri:noRegion>Sklodowskiej-Curie Warsawa</wicri:noRegion></affiliation></author><author><name sortKey="Lejeune, F" sort="Lejeune, F" uniqKey="Lejeune F" first="F" last="Lejeune">F. 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Eggermont</name><affiliation wicri:level="1"><nlm:aff id="aff8"> University Amsterdam, The Netherlands</nlm:aff><country xml:lang="fr">Pays-Bas</country><wicri:regionArea> University Amsterdam</wicri:regionArea></affiliation><affiliation wicri:level="1"><nlm:aff id="aff9"> Institute Gustave Roussy Paris, France</nlm:aff><country xml:lang="fr">France</country><wicri:regionArea> Institute Gustave Roussy Paris</wicri:regionArea></affiliation></author></titleStmt><publicationStmt><idno type="wicri:source">PMC</idno><idno type="pmid">23589724</idno><idno type="pmc">3622410</idno><idno type="url">http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3622410</idno><idno type="RBID">PMC:3622410</idno><idno type="doi">10.3332/ecancer.2013.294</idno><date when="2013">2013</date><idno type="wicri:Area/Pmc/Corpus">003D90</idno><idno type="wicri:explorRef" wicri:stream="Pmc" wicri:step="Corpus" wicri:corpus="PMC">003D90</idno><idno type="wicri:Area/Pmc/Curation">003D89</idno><idno type="wicri:explorRef" wicri:stream="Pmc" wicri:step="Curation">003D89</idno><idno type="wicri:Area/Pmc/Checkpoint">001F50</idno><idno type="wicri:explorRef" wicri:stream="Pmc" wicri:step="Checkpoint">001F50</idno><idno type="wicri:Area/Ncbi/Merge">005826</idno><idno type="wicri:Area/Ncbi/Curation">005826</idno><idno type="wicri:Area/Ncbi/Checkpoint">005826</idno><idno type="wicri:Area/Main/Merge">003127</idno><idno type="wicri:Area/Main/Curation">003122</idno><idno type="wicri:Area/Main/Exploration">003122</idno><idno type="wicri:Area/France/Extraction">000147</idno></publicationStmt><sourceDesc><biblStruct><analytic><title xml:lang="en" level="a" type="main">Surgical management of melanoma: an EORTC Melanoma Group survey</title><author><name sortKey="Testori, A" sort="Testori, A" uniqKey="Testori A" first="A" last="Testori">A. Testori</name><affiliation wicri:level="1"><nlm:aff id="aff1"> European Institute of Oncology, Italy</nlm:aff><country xml:lang="fr">Italie</country><wicri:regionArea> European Institute of Oncology</wicri:regionArea></affiliation></author><author><name sortKey="Soteldo, J" sort="Soteldo, J" uniqKey="Soteldo J" first="J" last="Soteldo">J. Soteldo</name><affiliation wicri:level="1"><nlm:aff id="aff2"> Hospital De Clinicas, Caracas, Venezuela</nlm:aff><country xml:lang="fr">Venezuela</country><wicri:regionArea> Hospital De Clinicas, Caracas</wicri:regionArea><wicri:noRegion>Caracas</wicri:noRegion></affiliation></author><author><name sortKey="Powell, B" sort="Powell, B" uniqKey="Powell B" first="B" last="Powell">B. Powell</name><affiliation wicri:level="1"><nlm:aff id="aff3"> St. Georges Hospital, UK</nlm:aff><country xml:lang="fr">Royaume-Uni</country><wicri:regionArea> St. Georges Hospital</wicri:regionArea></affiliation></author><author><name sortKey="Sales, F" sort="Sales, F" uniqKey="Sales F" first="F" last="Sales">F. Sales</name><affiliation wicri:level="3"><nlm:aff id="aff4"> Institut Jules Bordet, Brussels</nlm:aff><country>Belgique</country><placeName><settlement type="city">Bruxelles</settlement><region nuts="2">Région de Bruxelles-Capitale</region></placeName><wicri:orgArea> Institut Jules Bordet</wicri:orgArea></affiliation></author><author><name sortKey="Borgognoni, L" sort="Borgognoni, L" uniqKey="Borgognoni L" first="L" last="Borgognoni">L. Borgognoni</name><affiliation wicri:level="1"><nlm:aff id="aff5"> Centro Regionale di Riferimento per il Melanoma, Ospedale S. M. Annunziata, Italy</nlm:aff><country xml:lang="fr">Italie</country><wicri:regionArea> Centro Regionale di Riferimento per il Melanoma, Ospedale S. M. Annunziata</wicri:regionArea><wicri:noRegion>Ospedale S. M. Annunziata</wicri:noRegion></affiliation></author><author><name sortKey="Rutkowski, P" sort="Rutkowski, P" uniqKey="Rutkowski P" first="P" last="Rutkowski">P. Rutkowski</name><affiliation wicri:level="1"><nlm:aff id="aff6"> Centrum Onkologii Instytut im Marii, Sklodowskiej-Curie Warsawa, Poland</nlm:aff><country xml:lang="fr">Pologne</country><wicri:regionArea> Centrum Onkologii Instytut im Marii, Sklodowskiej-Curie Warsawa</wicri:regionArea><wicri:noRegion>Sklodowskiej-Curie Warsawa</wicri:noRegion></affiliation></author><author><name sortKey="Lejeune, F" sort="Lejeune, F" uniqKey="Lejeune F" first="F" last="Lejeune">F. Lejeune</name><affiliation wicri:level="1"><nlm:aff id="aff7"> Centre Hospitalier Universitaire Vaudois, Switzerland</nlm:aff><country xml:lang="fr">Suisse</country><wicri:regionArea> Centre Hospitalier Universitaire Vaudois</wicri:regionArea></affiliation></author><author><name sortKey="Van Leeuwen, Pam" sort="Van Leeuwen, Pam" uniqKey="Van Leeuwen P" first="Pam" last="Van Leeuwen">Pam Van Leeuwen</name><affiliation wicri:level="1"><nlm:aff id="aff7"> Centre Hospitalier Universitaire Vaudois, Switzerland</nlm:aff><country xml:lang="fr">Suisse</country><wicri:regionArea> Centre Hospitalier Universitaire Vaudois</wicri:regionArea></affiliation></author><author><name sortKey="Eggermont, A" sort="Eggermont, A" uniqKey="Eggermont A" first="A" last="Eggermont">A. Eggermont</name><affiliation wicri:level="1"><nlm:aff id="aff8"> University Amsterdam, The Netherlands</nlm:aff><country xml:lang="fr">Pays-Bas</country><wicri:regionArea> University Amsterdam</wicri:regionArea></affiliation><affiliation wicri:level="1"><nlm:aff id="aff9"> Institute Gustave Roussy Paris, France</nlm:aff><country xml:lang="fr">France</country><wicri:regionArea> Institute Gustave Roussy Paris</wicri:regionArea></affiliation></author></analytic><series><title level="j">ecancermedicalscience</title><idno type="eISSN">1754-6605</idno><imprint><date when="2013">2013</date></imprint></series></biblStruct></sourceDesc></fileDesc><profileDesc><textClass></textClass></profileDesc></teiHeader><front><div type="abstract" xml:lang="en"><sec><title>Objectives:</title><p>The objective of the article is to explore the surgical practices and views in the treatment of melanoma within members and non-members of the EORTC Melanoma Group (MG) during the years 2003–2005. </p></sec><sec id="methods"><title>Methods:</title><p>An e-mail questionnaire (see <xref ref-type="app" rid="app_1">appendix</xref>) developed within the EORTC MG was sent to all melanoma units (MUs) of the EORTC (180) and to selected international centres between 2003 and 2005. The questionnaire investigated the different practices regarding surgical management of melanoma patients at all stages.</p></sec><sec><title>Results:</title><p>A total of 75 questionnaires were returned from centres in Europe (70), Israel (3), Australia (1) and the United States (1). Resection margins on primary melanoma vary according to AJCC 2002 staging. Sixty three of 75 MUs perform Sentinel node biopsy. Modified radical neck dissection is performed in 82% of MUs for macrometastases and in 80% of MUs for micrometastases. Most MUs surveyed perform all three levels of Berg axillary dissection whether for macrometastases (79%) or micrometastases (62%). An ilio inguinal-obturator dissection is proposed with macrometastases (41% of MUs), whereas 33% of MUs perform a pelvic dissection only if the Cloquet node is positive. Twenty five of 75 MUs perform an isolated limb perfusion with a therapeutic indication; three also as an adjuvant. The majority of MUs perform surgery for distant metastases including superficial (53 of 75 [71%]) or solitary visceral metastases (52 of 75[69%]) or for palliation (58 of 75[77%]).</p></sec><sec><title>Conclusion:</title><p>The adequacy of surgery appears to be the most important milestone in the therapeutic approach of melanoma. Even if surgery is fundamental in the different stages of the disease, there is quite a variability concerning the extension of the surgical treatment related to primary and lymphnodal disease. Phase III randomised trials have shown that wide margins, elective lymph node dissections, and prophylactic isolated limb perfusions have not improved survival and cannot be considered the standard of care in the routine management of primary melanoma. The surgical subgroup of the EORTC Melanoma Group is developing a new version of the surgical survey questionnaire including new treatment modalities like isolated limb infusion and electrochemotherapy, which were not frequently in use some years ago, to obtain new data to be compared to the nearly ten-year-old data.</p></sec></div></front><back><div1 type="bibliography"><listBibl><biblStruct><analytic><author><name sortKey="Veronesi, U" uniqKey="Veronesi U">U Veronesi</name></author><author><name sortKey="Cascinelli, N" uniqKey="Cascinelli N">N Cascinelli</name></author><author><name sortKey="Adamus, J" uniqKey="Adamus J">J Adamus</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Cascinelli, N" uniqKey="Cascinelli N">N Cascinelli</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Banzet, P" uniqKey="Banzet P">P Banzet</name></author><author><name sortKey="Thomas, A" uniqKey="Thomas A">A 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sortKey="Eggermont, Amm" uniqKey="Eggermont A">AMM Eggermont</name></author><author><name sortKey="Gerschenwald, Je" uniqKey="Gerschenwald J">JE Gerschenwald</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Eggermont, Amm" uniqKey="Eggermont A">AMM Eggermont</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Eggermont, Amm" uniqKey="Eggermont A">AMM Eggermont</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Van Akkooi, Ac" uniqKey="Van Akkooi A">AC Van Akkooi</name></author><author><name sortKey="Dewilt, Jh" uniqKey="Dewilt J">JH DeWilt</name></author><author><name sortKey="Verhoef, C" uniqKey="Verhoef C">C Verhoef</name></author><author><name sortKey="Schmitz, Pi" uniqKey="Schmitz P">PI Schmitz</name></author><author><name sortKey="Van Geel, An" uniqKey="Van Geel A">AN Van Geel</name></author><author><name sortKey="Eggermont, Am" uniqKey="Eggermont A">AM 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Graveland</name></author><author><name sortKey="Van Geel, An" uniqKey="Van Geel A">AN van Geel</name></author><author><name sortKey="De Wilt, Jh" uniqKey="De Wilt J">JH de Wilt</name></author><author><name sortKey="Eggermont, Am" uniqKey="Eggermont A">AM Eggermont</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Eggermont, Am" uniqKey="Eggermont A">AM Eggermont</name></author><author><name sortKey="Van Geel, An" uniqKey="Van Geel A">AN van Geel</name></author><author><name sortKey="De Wilt, Jh" uniqKey="De Wilt J">JH de Wilt</name></author><author><name sortKey="Ten Hagen, Tl" uniqKey="Ten Hagen T">TL ten Hagen</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Morton, Dl" uniqKey="Morton D">DL Morton</name></author><author><name sortKey="Thompson, Jf" uniqKey="Thompson J">JF Thompson</name></author><author><name sortKey="Cochran, Aj" uniqKey="Cochran A">AJ Cochran</name></author><author><name sortKey="Mozzillo, N" uniqKey="Mozzillo N">N Mozzillo</name></author><author><name sortKey="Elashoff, R" uniqKey="Elashoff R">R Elashoff</name></author><author><name sortKey="Essner, R" uniqKey="Essner R">R Essner</name></author><author><name sortKey="Nieweg, Oe" uniqKey="Nieweg O">OE Nieweg</name></author><author><name sortKey="Roses, Df" uniqKey="Roses D">DF Roses</name></author><author><name sortKey="Hoekstra, Hj" uniqKey="Hoekstra H">HJ Hoekstra</name></author><author><name sortKey="Karakousis, Cp" uniqKey="Karakousis C">CP Karakousis</name></author><author><name sortKey="Reintgen, Ds" uniqKey="Reintgen D">DS Reintgen</name></author><author><name sortKey="Coventry, Bj" uniqKey="Coventry B">BJ Coventry</name></author><author><name sortKey="Glass, Ec" uniqKey="Glass E">EC Glass</name></author><author><name sortKey="Wang, Hj" uniqKey="Wang H">HJ Wang</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Luc, Jas" uniqKey="Luc J">JAS Luc</name></author><author><name sortKey="Arjen, J" uniqKey="Arjen J">J Arjen</name></author><author><name sortKey="Augustinus, Amh" uniqKey="Augustinus A">AMH Augustinus</name></author><author><name sortKey="Johannes, Lp" uniqKey="Johannes L">LP Johannes</name></author><author><name sortKey="Theo, W" uniqKey="Theo W">W Theo</name></author><author><name sortKey="Omgo, En" uniqKey="Omgo E">EN Omgo</name></author><author><name sortKey="Bin, Brk" uniqKey="Bin B">BRK Bin</name></author></analytic></biblStruct></listBibl></div1></back></TEI><affiliations><list><country><li>Belgique</li><li>France</li><li>Italie</li><li>Pays-Bas</li><li>Pologne</li><li>Royaume-Uni</li><li>Suisse</li><li>Venezuela</li></country><region><li>Région de Bruxelles-Capitale</li></region><settlement><li>Bruxelles</li></settlement></list><tree><country name="Italie"><noRegion><name sortKey="Testori, A" sort="Testori, A" uniqKey="Testori A" first="A" last="Testori">A. Testori</name></noRegion><name sortKey="Borgognoni, L" sort="Borgognoni, L" uniqKey="Borgognoni L" first="L" last="Borgognoni">L. Borgognoni</name></country><country name="Venezuela"><noRegion><name sortKey="Soteldo, J" sort="Soteldo, J" uniqKey="Soteldo J" first="J" last="Soteldo">J. Soteldo</name></noRegion></country><country name="Royaume-Uni"><noRegion><name sortKey="Powell, B" sort="Powell, B" uniqKey="Powell B" first="B" last="Powell">B. Powell</name></noRegion></country><country name="Belgique"><region name="Région de Bruxelles-Capitale"><name sortKey="Sales, F" sort="Sales, F" uniqKey="Sales F" first="F" last="Sales">F. Sales</name></region></country><country name="Pologne"><noRegion><name sortKey="Rutkowski, P" sort="Rutkowski, P" uniqKey="Rutkowski P" first="P" last="Rutkowski">P. Rutkowski</name></noRegion></country><country name="Suisse"><noRegion><name sortKey="Lejeune, F" sort="Lejeune, F" uniqKey="Lejeune F" first="F" last="Lejeune">F. Lejeune</name></noRegion><name sortKey="Van Leeuwen, Pam" sort="Van Leeuwen, Pam" uniqKey="Van Leeuwen P" first="Pam" last="Van Leeuwen">Pam Van Leeuwen</name></country><country name="Pays-Bas"><noRegion><name sortKey="Eggermont, A" sort="Eggermont, A" uniqKey="Eggermont A" first="A" last="Eggermont">A. Eggermont</name></noRegion></country><country name="France"><noRegion><name sortKey="Eggermont, A" sort="Eggermont, A" uniqKey="Eggermont A" first="A" last="Eggermont">A. Eggermont</name></noRegion></country></tree></affiliations></record>Pour manipuler ce document sous Unix (Dilib)
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