Tumor doubling time: A selection factor for pulmonary resection of metastatic melanoma
✍ Scribed by Ollila, David W.; Stern, Stacey L.; Morton, Donald L.
- Publisher
- John Wiley and Sons
- Year
- 1998
- Tongue
- English
- Weight
- 166 KB
- Volume
- 69
- Category
- Article
- ISSN
- 0022-4790
No coin nor oath required. For personal study only.
✦ Synopsis
Background and objectives:
Melanoma patients have a 20-27% rate of 5-year survival after surgical resection of pulmonary metastases. we evaluated tumor doubling time (tdt) and other prognostic factors in an attempt to identify candidates for pulmonary metastasectomy.
Methods:
Review of our large melanoma database identified 129 patients who underwent complete or partial resection of pulmonary metastases. at least two preoperative chest roentgenograms were available for 45 patients; these images were used by a single examiner to measure tumor width and length. the mean of the diameters was plotted against time on semilogarithmic paper: the slope of the line approximated tumor growth rate, and tdt was proportional to the inverse of the tumor growth rate.
Results:
For the 45 patients with a calculated tdt, median survival was 23.1 months and 5-year survival rate was 15.6% (7/45). by multivariate analysis, the only prognostically significant factors were tdt (p=0.006) and type of pulmonary resection (p=0.022). when tdt was <60 days, median survival was 16.0 months, and 5-year survival rate was zero; when tdt was > or = 60 days, median survival was 29.2 months (log-rank test; significant at p < 0.0001) and 5-year survival rate was 20.7% (6/29) (p < 0.0001).
Conclusions:
Tdt is the most significant preoperative prognostic factor for patients undergoing pulmonary resection of metastatic melanoma. if tdt is <60 days, a preoperative neoadjuvant regimen of chemotherapy and biologic therapy is recommended. pulmonary metastasectomy should not be attempted if tdt cannot be increased to > or = 60 days by systemic therapy.