1
|
Falcone R, Verkhovskaia S, Di Pietro FR, Poti G, Samela T, Carbone ML, Morelli MF, Zappalà AR, di Rocco ZC, Morese R, Piesco G, Marchetti P, Failla CM, De Galitiis F. Primary Mucosal Melanoma: Clinical Experience from a Single Italian Center. Curr Oncol 2024; 31:588-597. [PMID: 38275835 PMCID: PMC10814710 DOI: 10.3390/curroncol31010042] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2023] [Revised: 01/13/2024] [Accepted: 01/19/2024] [Indexed: 01/27/2024] Open
Abstract
(1) Background: Mucosal melanoma (MM) is a rare tumor, accounting for about 1% of all diagnosed melanomas. The etiology and pathogenesis of this tumor are unknown. It is characterized by an aggressive phenotype with poor prognosis and a low response rate to approved treatments. (2) Methods: We retrospectively analyzed the clinical features, treatments and outcomes of patients diagnosed with MM from different sub-sites (head and neck, gynecological and gastro-intestinal region) between 2013 and 2023 at our Institute. Survival times were estimated with the Kaplan-Meier method. Multivariate Cox regression was used to test the independence of significant factors in univariate analysis. (3) Results: Twenty-five patients were included in this study; the disease was equally distributed among females and males. The median age at diagnosis was 74 years old. The majority had MM originating from the head and neck (56%), particularly from the nasal cavity. BRAF V600 mutations were detected in 16% of the study population, limited to gastro-intestinal and gynecological MM. At diagnosis, at least half the patients (52%) had the disease located also at distant sites. The median overall survival (OS) in the whole study population was 22 months, with a longer OS for patients diagnosed at an early stage (38 months, p < 0.001). Longer OSs were reported for head and neck MM compared to other anatomic regions (0.06). Surgery of the primary tumor and radiotherapy were performed in 64% and 36% of the study population, respectively. Radiotherapy was performed only in head and neck MM. At multivariate analysis, the single factor that showed a reduced hazard ratio for death was radiotherapy. (4) Conclusions: The overall survival of MM from different sub-sites treated at our Italian Institution was 22 months, with better outcomes for early-stage disease and head and neck MM. Performing radiotherapy may have a protective effect on OS for head and neck MM. New treatment strategies are urgently needed to improve the outcome in this disease.
Collapse
Affiliation(s)
- Rosa Falcone
- Department of Oncology, IDI-IRCCS, 00167 Rome, Italy; (S.V.); (F.R.D.P.); (G.P.); (T.S.); (M.F.M.); (A.R.Z.); (Z.C.d.R.); (R.M.); (G.P.); (P.M.); (F.D.G.)
| | - Sofia Verkhovskaia
- Department of Oncology, IDI-IRCCS, 00167 Rome, Italy; (S.V.); (F.R.D.P.); (G.P.); (T.S.); (M.F.M.); (A.R.Z.); (Z.C.d.R.); (R.M.); (G.P.); (P.M.); (F.D.G.)
| | - Francesca Romana Di Pietro
- Department of Oncology, IDI-IRCCS, 00167 Rome, Italy; (S.V.); (F.R.D.P.); (G.P.); (T.S.); (M.F.M.); (A.R.Z.); (Z.C.d.R.); (R.M.); (G.P.); (P.M.); (F.D.G.)
| | - Giulia Poti
- Department of Oncology, IDI-IRCCS, 00167 Rome, Italy; (S.V.); (F.R.D.P.); (G.P.); (T.S.); (M.F.M.); (A.R.Z.); (Z.C.d.R.); (R.M.); (G.P.); (P.M.); (F.D.G.)
| | - Tonia Samela
- Department of Oncology, IDI-IRCCS, 00167 Rome, Italy; (S.V.); (F.R.D.P.); (G.P.); (T.S.); (M.F.M.); (A.R.Z.); (Z.C.d.R.); (R.M.); (G.P.); (P.M.); (F.D.G.)
| | - Maria Luigia Carbone
- Experimental Immunology Laboratory, IDI-IRCCS, 00167 Rome, Italy; (M.L.C.); (C.M.F.)
| | - Maria Francesca Morelli
- Department of Oncology, IDI-IRCCS, 00167 Rome, Italy; (S.V.); (F.R.D.P.); (G.P.); (T.S.); (M.F.M.); (A.R.Z.); (Z.C.d.R.); (R.M.); (G.P.); (P.M.); (F.D.G.)
| | - Albina Rita Zappalà
- Department of Oncology, IDI-IRCCS, 00167 Rome, Italy; (S.V.); (F.R.D.P.); (G.P.); (T.S.); (M.F.M.); (A.R.Z.); (Z.C.d.R.); (R.M.); (G.P.); (P.M.); (F.D.G.)
| | - Zorika Christiana di Rocco
- Department of Oncology, IDI-IRCCS, 00167 Rome, Italy; (S.V.); (F.R.D.P.); (G.P.); (T.S.); (M.F.M.); (A.R.Z.); (Z.C.d.R.); (R.M.); (G.P.); (P.M.); (F.D.G.)
| | - Roberto Morese
- Department of Oncology, IDI-IRCCS, 00167 Rome, Italy; (S.V.); (F.R.D.P.); (G.P.); (T.S.); (M.F.M.); (A.R.Z.); (Z.C.d.R.); (R.M.); (G.P.); (P.M.); (F.D.G.)
| | - Gabriele Piesco
- Department of Oncology, IDI-IRCCS, 00167 Rome, Italy; (S.V.); (F.R.D.P.); (G.P.); (T.S.); (M.F.M.); (A.R.Z.); (Z.C.d.R.); (R.M.); (G.P.); (P.M.); (F.D.G.)
| | - Paolo Marchetti
- Department of Oncology, IDI-IRCCS, 00167 Rome, Italy; (S.V.); (F.R.D.P.); (G.P.); (T.S.); (M.F.M.); (A.R.Z.); (Z.C.d.R.); (R.M.); (G.P.); (P.M.); (F.D.G.)
| | - Cristina Maria Failla
- Experimental Immunology Laboratory, IDI-IRCCS, 00167 Rome, Italy; (M.L.C.); (C.M.F.)
| | - Federica De Galitiis
- Department of Oncology, IDI-IRCCS, 00167 Rome, Italy; (S.V.); (F.R.D.P.); (G.P.); (T.S.); (M.F.M.); (A.R.Z.); (Z.C.d.R.); (R.M.); (G.P.); (P.M.); (F.D.G.)
| |
Collapse
|
2
|
Ronchi S, Cicchetti A, Bonora M, Ingargiola R, Camarda AM, Russo S, Imparato S, Castelnuovo P, Pasquini E, Nicolai P, Ansarin M, Del Vecchio M, Benazzo M, Orlandi E, Vischioni B. Curative carbon ion radiotherapy in a head and neck mucosal melanoma series: Facing the future within multidisciplinarity. Radiother Oncol 2024; 190:110003. [PMID: 37956889 DOI: 10.1016/j.radonc.2023.110003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2023] [Revised: 11/05/2023] [Accepted: 11/10/2023] [Indexed: 11/15/2023]
Abstract
PURPOSE To evaluate efficacy and toxicity of carbon ion radiotherapy (CIRT) in locally advanced head and neck mucosal melanoma (HNMM) patients treated at our Institute. MATERIALS AND METHODS Between June 2013 and June 2020, 40 HNMM patients were treated with CIRT. Prescription dose was 65.6-68.8 Gy relative biological effectiveness [RBE] in 16 fractions. Twelve (30%) patients received only biopsy, 28 (70%) surgical resection before CIRT. Immunotherapy was administered before and/or after CIRT in 45% of patients, mainly for distant progression (89%). RESULTS Median follow-up was 18 months. 2-year Local Relapse Free Survival (LRFS), Overall Survival (OS), Progression Free Survival (PFS) and Distant Metastasis Free Survival (DMFS) were 84.5%, 58.6%, 33.2% and 37.3%, respectively. At univariate analysis, LRFS was significantly better for non-recurrent status, < 2 surgeries before CIRT and treatment started < 9 months from the initial diagnosis, with no significant differences for operated versus unresected patients. After relapse, immunotherapy provided longer median OS (17 months vs 3.6, p-value<0.001). Late toxicity ≥ G3 (graded with CTCAE 5.0 scale) was reported in 10% of patients. CONCLUSION CIRT in advanced HNMM patients is safe and locally effective. Prospective trials are warranted to assess the role of targeted/immune- systemic therapy to improve OS.
Collapse
Affiliation(s)
- Sara Ronchi
- Radiation Oncology Unit, Clinical Department, National Center for Oncological Hadrontherapy (CNAO), Pavia, Italy.
| | - Alessandro Cicchetti
- Prostate Cancer Program, Fondazione IRCCS Istituto Nazionale dei Tumori, Via Giacomo Venezian, 1, 20133 Milano, Italy
| | - Maria Bonora
- Radiation Oncology Unit, Clinical Department, National Center for Oncological Hadrontherapy (CNAO), Pavia, Italy
| | - Rossana Ingargiola
- Radiation Oncology Unit, Clinical Department, National Center for Oncological Hadrontherapy (CNAO), Pavia, Italy
| | - Anna Maria Camarda
- Radiation Oncology Unit, Clinical Department, National Center for Oncological Hadrontherapy (CNAO), Pavia, Italy
| | - Stefania Russo
- Medical Physics Unit, Clinical Department, National Center for Oncological Hadrontherapy (CNAO), Pavia, Italy
| | - Sara Imparato
- Radiology Unit, Clinical Department, National Center for Oncological Hadrontherapy (CNAO), Pavia, Italy
| | - Paolo Castelnuovo
- Department of Otorhinolaryngology, Department of Biotechnology and Life Sciences, University of Insubria, Varese, Italy; Head and Neck Surgery & Forensic Dissection Research Center (HNS&FDRc), Department of Biotechnology and Life Sciences, University of Insubria, Varese, Italy
| | - Ernesto Pasquini
- Azienda USL di Bologna, ENT Department, Bellaria Hospital, Bologna, Italy
| | - Piero Nicolai
- Section of Otorhinolaryngology - Head and Neck Surgery, Department of Neurosciences, University of Padua - "Azienda Ospedaliera di Padova", Padua, Italy
| | - Mohssen Ansarin
- Division of Otolaryngology and Head and Neck Surgery, IEO, European Institute of Oncology IRCCS, Milan, Italy
| | - Michele Del Vecchio
- Unit of Melanoma Medical Oncology, Department of Medical Oncology and Hematology, Fondazione IRCCS Istituto Nazionale dei Tumori, Via Giacomo Venezian 1, Milan 20133, Italy
| | - Marco Benazzo
- Department of Otolaryngology Head Neck Surgery, University of Pavia, IRCCS Policlinico San Matteo Foundation, Pavia, Italy
| | - Ester Orlandi
- Radiation Oncology Unit, Clinical Department, National Center for Oncological Hadrontherapy (CNAO), Pavia, Italy
| | - Barbara Vischioni
- Radiation Oncology Unit, Clinical Department, National Center for Oncological Hadrontherapy (CNAO), Pavia, Italy
| |
Collapse
|
3
|
Shinada M, Kato D, Motegi T, Tsuboi M, Ikeda N, Aoki S, Iguchi T, Li T, Kodera Y, Ota R, Hashimoto Y, Takahashi Y, Chambers J, Uchida K, Kato Y, Nishimura R, Nakagawa T. Podoplanin Drives Amoeboid Invasion in Canine and Human Mucosal Melanoma. Mol Cancer Res 2023; 21:1205-1219. [PMID: 37493578 DOI: 10.1158/1541-7786.mcr-22-0929] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2022] [Revised: 04/09/2023] [Accepted: 07/13/2023] [Indexed: 07/27/2023]
Abstract
Mucosal melanoma metastasizes at an early stage of the disease in human and dog. We revealed that overexpression of podoplanin in tumor invasion fronts (IF) was related to poor prognosis of dogs with mucosal melanoma. Moreover, podoplanin expressed in canine mucosal melanoma cells promotes proliferation and aggressive amoeboid invasion by activating Rho-associated kinase (ROCK)-myosin light chain 2 (MLC2) signaling. PDPN-ROCK-MLC2 signaling plays a role in cell-cycle arrest and cellular senescence escape as a mechanism for regulating proliferation. Podoplanin induces amoeboid invasion in the IFs of mouse xenografted tumor tissues, similar to canine mucosal melanoma clinical samples. We further identified that podoplanin expression was related to poor prognosis of human patients with mucosal melanoma, and human mucosal melanoma with podoplanin-high expression enriched gene signatures related to amoeboid invasion, similar to canine mucosal melanoma. Overall, we propose that podoplanin promotes canine and human mucosal melanoma metastasis by inducing aggressive amoeboid invasion and naturally occurring canine mucosal melanoma can be a novel research model for podoplanin expressing human mucosal melanoma. IMPLICATIONS Podoplanin could be a new therapeutic target to restrict the metastatic dissemination of canine and human mucosal melanoma.
Collapse
Affiliation(s)
- Masahiro Shinada
- Laboratory of Veterinary Surgery, Graduate School of Agricultural and Life Sciences, The University of Tokyo, Tokyo, Japan
| | - Daiki Kato
- Laboratory of Veterinary Surgery, Graduate School of Agricultural and Life Sciences, The University of Tokyo, Tokyo, Japan
| | - Tomoki Motegi
- Veterinary Medical Center, The University of Tokyo, Tokyo, Japan
| | - Masaya Tsuboi
- Veterinary Medical Center, The University of Tokyo, Tokyo, Japan
| | - Namiko Ikeda
- Laboratory of Veterinary Surgery, Graduate School of Agricultural and Life Sciences, The University of Tokyo, Tokyo, Japan
| | - Susumu Aoki
- Laboratory of Veterinary Surgery, Graduate School of Agricultural and Life Sciences, The University of Tokyo, Tokyo, Japan
| | - Takaaki Iguchi
- Laboratory of Veterinary Surgery, Graduate School of Agricultural and Life Sciences, The University of Tokyo, Tokyo, Japan
| | - Toshio Li
- Laboratory of Veterinary Surgery, Graduate School of Agricultural and Life Sciences, The University of Tokyo, Tokyo, Japan
| | - Yuka Kodera
- Laboratory of Veterinary Surgery, Graduate School of Agricultural and Life Sciences, The University of Tokyo, Tokyo, Japan
| | - Ryosuke Ota
- Laboratory of Veterinary Surgery, Graduate School of Agricultural and Life Sciences, The University of Tokyo, Tokyo, Japan
| | - Yuko Hashimoto
- Veterinary Medical Center, The University of Tokyo, Tokyo, Japan
| | - Yosuke Takahashi
- Veterinary Medical Center, The University of Tokyo, Tokyo, Japan
| | - James Chambers
- Laboratory of Veterinary Pathology, Graduate School of Agricultural and Life Sciences, The University of Tokyo, Tokyo, Japan
| | - Kazuyuki Uchida
- Laboratory of Veterinary Pathology, Graduate School of Agricultural and Life Sciences, The University of Tokyo, Tokyo, Japan
| | - Yukinari Kato
- Department of Antibody Drug Development, Tohoku University Graduate School of Medicine, Miyagi, Japan
- Department of Molecular Pharmacology, Tohoku University Graduate School of Medicine, Miyagi, Japan
| | - Ryohei Nishimura
- Laboratory of Veterinary Surgery, Graduate School of Agricultural and Life Sciences, The University of Tokyo, Tokyo, Japan
| | - Takayuki Nakagawa
- Laboratory of Veterinary Surgery, Graduate School of Agricultural and Life Sciences, The University of Tokyo, Tokyo, Japan
| |
Collapse
|
4
|
Guo J, Wang J, Cao J, Yang Y, Zhang Y, Song X. Nasal Malignant Melanoma With an Inverted Papilloma in the Contralateral Nasal Cavity: A Case Report. EAR, NOSE & THROAT JOURNAL 2023:1455613231179692. [PMID: 37291873 DOI: 10.1177/01455613231179692] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/10/2023] Open
Abstract
Background: We describe a patient with sinonasal mucosal melanoma (SNMM) and an inverted papilloma, which existed independently in both nasal cavities. Case presentation: We describe an unusual case of a 74-year-old male patient with SNMM and an inverted papilloma. He presented with symptoms of coughing up blood and pain in the left forehead. The patient underwent surgical resection of the lesion, and the SNMM and inverted papilloma were confirmed by histopathology. The patient refused further treatment after surgery, but was re-admitted 7 months later with local recurrence of the left tumor and systemic metastases. Conclusions: Nasal malignant melanoma with an inverted papilloma in the contralateral nasal cavity is rare and can easily be misdiagnosed as the same tumor by imaging. Simultaneous histopathology of bilateral nasal masses is very necessary. The recommended treatment is surgery for the inverted papilloma. An SNMM is a devastating tumor with poor outcomes.
Collapse
Affiliation(s)
- Jing Guo
- Department of Otorhinolaryngology, Head and Neck Surgery, Yantai Yuhuangding Hospital, Qingdao University, Yantai, Shandong, China
- Shandong Provincial Clinical Research Center for Otorhinolaryngologic Diseases, Yantai, Shandong, China
- Yantai Key Laboratory of Otorhinolaryngologic Diseases, Yantai, Shandong, China
| | - Jianwei Wang
- Department of Otorhinolaryngology, Head and Neck Surgery, Yantai Yuhuangding Hospital, Qingdao University, Yantai, Shandong, China
- Shandong Provincial Clinical Research Center for Otorhinolaryngologic Diseases, Yantai, Shandong, China
- Yantai Key Laboratory of Otorhinolaryngologic Diseases, Yantai, Shandong, China
| | - Jiayu Cao
- Department of Otorhinolaryngology, Head and Neck Surgery, Yantai Yuhuangding Hospital, Qingdao University, Yantai, Shandong, China
- Shandong Provincial Clinical Research Center for Otorhinolaryngologic Diseases, Yantai, Shandong, China
- Yantai Key Laboratory of Otorhinolaryngologic Diseases, Yantai, Shandong, China
| | - Yujuan Yang
- Department of Otorhinolaryngology, Head and Neck Surgery, Yantai Yuhuangding Hospital, Qingdao University, Yantai, Shandong, China
- Shandong Provincial Clinical Research Center for Otorhinolaryngologic Diseases, Yantai, Shandong, China
- Yantai Key Laboratory of Otorhinolaryngologic Diseases, Yantai, Shandong, China
| | - Yu Zhang
- Department of Otorhinolaryngology, Head and Neck Surgery, Yantai Yuhuangding Hospital, Qingdao University, Yantai, Shandong, China
- Shandong Provincial Clinical Research Center for Otorhinolaryngologic Diseases, Yantai, Shandong, China
- Yantai Key Laboratory of Otorhinolaryngologic Diseases, Yantai, Shandong, China
| | - Xicheng Song
- Department of Otorhinolaryngology, Head and Neck Surgery, Yantai Yuhuangding Hospital, Qingdao University, Yantai, Shandong, China
- Shandong Provincial Clinical Research Center for Otorhinolaryngologic Diseases, Yantai, Shandong, China
- Yantai Key Laboratory of Otorhinolaryngologic Diseases, Yantai, Shandong, China
| |
Collapse
|
5
|
Chen S, Li M, Liu J, Chen J, Wang J, Li H, Li X, Zhang Y, Song M, Lu J, Chen W. Treatment outcomes of mucosal melanoma of the head and neck: Analysis of 190 cases from a single institution. Laryngoscope Investig Otolaryngol 2023; 8:686-692. [PMID: 37342113 PMCID: PMC10278118 DOI: 10.1002/lio2.1072] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2022] [Revised: 03/16/2023] [Accepted: 04/17/2023] [Indexed: 06/22/2023] Open
Abstract
Objectives To analyze the treatment outcomes and prognostic factors of mucosal melanoma of the head and neck (MMHN) from a single institution. Methods From December 1989 to November 2018, 190 patients diagnosed with MMHN were included. Survival analysis was performed using the Kaplan-Meier method for univariate analysis with a log-rank test for significance and Cox regression for multivariate analysis. Results With a median follow-up time of 43.5 months, 126 (68.5%) patients died. The median DSS was 35 months. The 3- and 5-year disease-specific survival (DSS) rates were 48.1% and 33.7%, respectively. The median overall survival (OS) was 34 months. The 3- and 5-year OS rates were 47.0% and 32.9%, respectively. In univariate analysis, the T3 stage, received surgery, R0 resection, and combined therapy (surgery+biotherapy/biochemotherapy) were significantly associated with better survival. Multivariable Cox regression analysis revealed that the T4 stage (HR = 1.692; 95% CI, 1.175-2.438; p = .005) and the N1 stage (HR = 1.600; 95% CI, 1.023-2.504; p = .039) were strong prognostic factors for poor survival, and that combined therapy (surgery+biotherapy/biochemotherapy) was a strong prognostic factor for better survival outcome (HR = 0.563; 95% CI, 0.354-0.896; p = .015). Conclusion The prognosis of MMHN remains poor. Systemic treatment is warranted to reduce MMHN progression. Surgery combined with biotherapy may improve survival.
Collapse
Affiliation(s)
- Shu‐Wei Chen
- Department of Head and Neck Surgery, Sun Yat‐sen University Cancer Center, State Key Laboratory of Oncology in South ChinaCollaborative Innovation Center of Cancer MedicineGuangzhouGuangdongChina
| | - Meng‐Hua Li
- Department of Head and Neck Surgery, Sun Yat‐sen University Cancer Center, State Key Laboratory of Oncology in South ChinaCollaborative Innovation Center of Cancer MedicineGuangzhouGuangdongChina
| | - Jian‐Liang Liu
- Department of Head and Neck Surgery, Sun Yat‐sen University Cancer Center, State Key Laboratory of Oncology in South ChinaCollaborative Innovation Center of Cancer MedicineGuangzhouGuangdongChina
| | - Jing‐Tao Chen
- Department of Head and Neck Surgery, Sun Yat‐sen University Cancer Center, State Key Laboratory of Oncology in South ChinaCollaborative Innovation Center of Cancer MedicineGuangzhouGuangdongChina
| | - Jia Wang
- Department of Head and Neck Surgery, Sun Yat‐sen University Cancer Center, State Key Laboratory of Oncology in South ChinaCollaborative Innovation Center of Cancer MedicineGuangzhouGuangdongChina
| | - Hui Li
- Department of Head and Neck Surgery, Sun Yat‐sen University Cancer Center, State Key Laboratory of Oncology in South ChinaCollaborative Innovation Center of Cancer MedicineGuangzhouGuangdongChina
| | - Xi‐Yuan Li
- Department of Head and Neck Surgery, Sun Yat‐sen University Cancer Center, State Key Laboratory of Oncology in South ChinaCollaborative Innovation Center of Cancer MedicineGuangzhouGuangdongChina
| | - Ying Zhang
- Department of Head and Neck Surgery, Sun Yat‐sen University Cancer Center, State Key Laboratory of Oncology in South ChinaCollaborative Innovation Center of Cancer MedicineGuangzhouGuangdongChina
| | - Ming Song
- Department of Head and Neck Surgery, Sun Yat‐sen University Cancer Center, State Key Laboratory of Oncology in South ChinaCollaborative Innovation Center of Cancer MedicineGuangzhouGuangdongChina
| | - Jia‐Xuan Lu
- Department of Pediatric Dentistry, Guanghua School of Stomatology, Affiliated Stomatological HospitalGuangdong Provincial Key Laboratory of Stomatology, Sun Yat‐sen UniversityGuangzhouGuangdongChina
| | - Wen‐Kuan Chen
- Department of Head and Neck Surgery, Sun Yat‐sen University Cancer Center, State Key Laboratory of Oncology in South ChinaCollaborative Innovation Center of Cancer MedicineGuangzhouGuangdongChina
| |
Collapse
|
6
|
Hovhannisyan L, Riether C, Aebersold DM, Medová M, Zimmer Y. CAR T cell-based immunotherapy and radiation therapy: potential, promises and risks. Mol Cancer 2023; 22:82. [PMID: 37173782 PMCID: PMC10176707 DOI: 10.1186/s12943-023-01775-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2023] [Accepted: 04/11/2023] [Indexed: 05/15/2023] Open
Abstract
CAR T cell-based therapies have revolutionized the treatment of hematological malignancies such as leukemia and lymphoma within the last years. In contrast to the success in hematological cancers, the treatment of solid tumors with CAR T cells is still a major challenge in the field and attempts to overcome these hurdles have not been successful yet. Radiation therapy is used for management of various malignancies for decades and its therapeutic role ranges from local therapy to a priming agent in cancer immunotherapy. Combinations of radiation with immune checkpoint inhibitors have already proven successful in clinical trials. Therefore, a combination of radiation therapy may have the potential to overcome the current limitations of CAR T cell therapy in solid tumor entities. So far, only limited research was conducted in the area of CAR T cells and radiation. In this review we will discuss the potential and risks of such a combination in the treatment of cancer patients.
Collapse
Affiliation(s)
- Lusine Hovhannisyan
- Department of Radiation Oncology, Inselspital, Bern University Hospital, Freiburgstrasse 8, Bern, 3008, Switzerland
- Department for Biomedical Research, Radiation Oncology, University of Bern, Murtenstrasse 35, Bern, 3008, Switzerland
- Graduate School for Cellular and Biomedical Sciences, University of Bern, Bern, 3010, Switzerland
| | - Carsten Riether
- Department of Medical Oncology, Inselspital, University Hospital and University of Bern, Bern, 3010, Switzerland
| | - Daniel M Aebersold
- Department of Radiation Oncology, Inselspital, Bern University Hospital, Freiburgstrasse 8, Bern, 3008, Switzerland
- Department for Biomedical Research, Radiation Oncology, University of Bern, Murtenstrasse 35, Bern, 3008, Switzerland
| | - Michaela Medová
- Department of Radiation Oncology, Inselspital, Bern University Hospital, Freiburgstrasse 8, Bern, 3008, Switzerland
- Department for Biomedical Research, Radiation Oncology, University of Bern, Murtenstrasse 35, Bern, 3008, Switzerland
| | - Yitzhak Zimmer
- Department of Radiation Oncology, Inselspital, Bern University Hospital, Freiburgstrasse 8, Bern, 3008, Switzerland.
- Department for Biomedical Research, Radiation Oncology, University of Bern, Murtenstrasse 35, Bern, 3008, Switzerland.
| |
Collapse
|
7
|
Young K, Arkfeld DV, Ogasawara CT, Squires LD. A Systematic Review of Primary Temporal Bone Mucosal Melanoma. Otol Neurotol 2023; 44:e118-e124. [PMID: 36729861 DOI: 10.1097/mao.0000000000003775] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
OBJECTIVE Temporal bone mucosal melanomas (MMs) are rare, and patients may experience delays in diagnosis and treatment. Our objective was to better characterize the presentation, diagnosis, treatment modalities, and outcomes of this process. DATA SOURCES PubMed/Medline, CINAHL (EBSCOhost), and Web of Science databases were searched in all languages without restriction of publication dates. STUDY SELECTION Inclusion criteria included that the article was either a case report or a case series with individual case data. All non-English articles were excluded if the corresponding abstract lacked data on demographics, initial presentation, and clinical management. DATA EXTRACTION After full-text analysis, data pertaining to demographics, diagnosis, medical and surgical management modalities, and outcomes were extracted. DATA SYNTHESIS Data were qualitatively synthesized, and means and averages were obtained for all continuous variables. Overall survival was measured by the Kaplan-Meier method, and significance was measured through log-rank testing. CONCLUSIONS Clinicians should suspect temporal bone MM in the differential diagnosis of patients with bloody otorrhea in the context of a chronic serous otitis media or an associated cranial nerve palsy. If suspected, physicians should not delay the acquisition of a biopsy or imaging studies. Management is highly variable and must be decided on a case-by-case basis. Outcomes remain poor because of the high propensity for MM to metastasize.
Collapse
Affiliation(s)
- Kurtis Young
- University of Hawai'i at Mānoa John A. Burns School of Medicine, Honolulu, Hawaii
| | | | | | | |
Collapse
|
8
|
Haimowitz S, Cohen DA, Dhanda A, Barron K, Povolotskiy R, Roden D. Mucosal Melanoma of the Oral Cavity: What is the Role of Elective Neck Dissection? Laryngoscope 2023; 133:317-326. [PMID: 35560997 PMCID: PMC10084066 DOI: 10.1002/lary.30152] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2022] [Accepted: 04/05/2022] [Indexed: 01/19/2023]
Abstract
OBJECTIVES Mucosal melanoma (MM) is a rare malignancy that can present in the head and neck (H&N). The Oral cavity is the second most common primary site in the H&N after sinonasal mucosa. This study investigates the impact of demographic and clinical factors on survival in oral cavity MM. Further, it investigates the outcomes and utility of elective neck dissections (END) in the management of oral MM. METHODS The National Cancer Database was used to evaluate 432 patients with oral cavity MM from 2004 to 2016. Kaplan-Meir and Cox regression analyses were used to determine variables associated with survival. RESULTS The mean age was 64.0 ± 16.0 years. Most patients were white (85.1%) and male (60.0%). Gingiva (37.6%) and hard palate (36.1%) were the most common primary subsites in the oral cavity. Five-year overall survival was 31.0%. Age (Hazards Ratio [95% Confidence Interval], 1.03 [1.01-1.06]), N-stage (1.94 [1.10-3.42]), M-stage (10.13 [3.33-30.86]), male sex (1.79 [1.06-3.03]), and African-American race (2.63 [1.14-6.11]) were significantly associated with worse survival. 199 patients (46.9%) underwent neck dissection including 118 with lymph node yield (LNY) ≥ 18. The rate of occult nodal positivity was 45.4% for LNY ≥ 18 and 28.3% for LNY ≥ 1. ENDs were not associated with improved outcomes. However, occult lymph node involvement was associated with worse overall survival (p = 0.004). CONCLUSIONS Oral cavity MM has a poor prognosis. Lymph node involvement, distant metastasis, age, race, and male sex are associated with worse outcomes. Performing an END did not improve survival. However, END may have a prognostic role and help select patients for treatment intensification. LEVEL OF EVIDENCE 4 Laryngoscope, 133:317-326, 2023.
Collapse
Affiliation(s)
- Sean Haimowitz
- Department of Otolaryngology - Head and Neck Surgery, Rutgers New Jersey Medical School, Newark, New Jersey, U.S.A
| | - David A Cohen
- Department of Otolaryngology - Head and Neck Surgery, Rutgers New Jersey Medical School, Newark, New Jersey, U.S.A
| | - Aatin Dhanda
- Department of Otolaryngology - Head and Neck Surgery, Rutgers New Jersey Medical School, Newark, New Jersey, U.S.A
| | - Kendyl Barron
- Department of Otolaryngology - Head and Neck Surgery, Rutgers New Jersey Medical School, Newark, New Jersey, U.S.A
| | - Roman Povolotskiy
- Department of Otolaryngology - Head and Neck Surgery, Rutgers New Jersey Medical School, Newark, New Jersey, U.S.A
| | - Dylan Roden
- Department of Otolaryngology - Head and Neck Surgery, Rutgers New Jersey Medical School, Newark, New Jersey, U.S.A
| |
Collapse
|
9
|
Mitra D, Farr M, Nagarajan P, Ho J, Bishop AJ, Jhingran A, Farooqi AS, Frumovitz M, Amaria RN, McQuade JL, Jazaeri AA, Guadagnolo BA. Gynecologic tract melanoma in the contemporary therapeutic era: High rates of local and distant disease progression. Gynecol Oncol 2022; 167:483-489. [PMID: 36229264 DOI: 10.1016/j.ygyno.2022.09.026] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2022] [Revised: 09/22/2022] [Accepted: 09/27/2022] [Indexed: 11/04/2022]
Abstract
BACKGROUND Gynecologic tract melanoma (GTM) is a rare malignancy with historically poor outcomes. The current study examines patterns of care and oncologic outcomes in a large single-institution cohort from the contemporary therapeutic era. METHODS Patterns of care and predictors of outcomes were evaluated for all GTM patients without metastatic disease at diagnosis who were treated at our institution between 2009 and 2020 with >6 months of follow-up. RESULTS Of the 124 patients included, anatomic subsites were vulvar (n = 82, 66%), vaginal (n = 34, 27%), or cervical (n = 8, 6%). Primary tumor was resected for 85% (n = 106) with surgical nodal evaluation for 60% (n = 75). Systemic therapy, most commonly immune checkpoint inhibitors (ICI, 58% systemic therapy), was used to treat all except one unresectable patient (17/18) and 33% (35/106) of resectable patients. Seven patients received neoadjuvant ICI. Fourteen patients received adjuvant radiation therapy to the pelvis (RT, 13% of those undergoing resection). With a median follow-up of 45 months, 100 patients (81%) recurred. Four-year actuarial outcomes were: 46% local control, 53% nodal control, 36% distant metastasis-free survival, 17% disease-free survival, 49% melanoma-specific survival and 48% overall survival. Mitotic rate > 10/mm2, nodal involvement and non-vulvar anatomic subsite were associated with poor outcomes. Patients treated after 2016 did not have significantly better outcomes than those treated earlier. CONCLUSIONS Patients with GTM continue to have poor outcomes in the contemporary therapeutic era with particularly notable poor local disease control relative to other mucosal melanoma subtypes. More effective oncologic therapy is needed.
Collapse
Affiliation(s)
- Devarati Mitra
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA.
| | - Morgan Farr
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Priyadharsini Nagarajan
- Department of Pathology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Joel Ho
- Department of Melanoma Medical Oncology, The University of Texas MD Anderson Cancer, Houston, TX, USA Center, USA
| | - Andrew J Bishop
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Anuja Jhingran
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Ahsan S Farooqi
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Michael Frumovitz
- Department of Gynecologic Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Rodabe N Amaria
- Department of Melanoma Medical Oncology, The University of Texas MD Anderson Cancer, Houston, TX, USA Center, USA
| | - Jennifer L McQuade
- Department of Melanoma Medical Oncology, The University of Texas MD Anderson Cancer, Houston, TX, USA Center, USA
| | - Amir A Jazaeri
- Department of Gynecologic Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - B Ashleigh Guadagnolo
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| |
Collapse
|
10
|
Tu J, Wang J, Tang B, Zhang Z, Han M, Li M, Yu J, Shen L, Zhang M, Ye J. Expression and clinical significance of TYRP1, ABCB5, and MMP17 in sinonasal mucosal melanoma. Cancer Biomark 2022; 35:331-342. [DOI: 10.3233/cbm-220093] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
BACKGROUND: Sinonasal mucosal melanoma (SNMM) is a lethal malignancy with poor prognosis. Treatment outcomes of SNMM are poor. Novel prognostic or progression markers are needed to help adjust therapy. METHODS: RNA-seq was used to analyze the mRNA expression of tumor tissues and normal nasal mucosa from primary SNMM patients (n= 3). Real-time fluorescent quantitative PCR (qRT-PCR) was used to validate the results of RNA-seq (n= 3), while protein expression was analyzed by immunohistochemistry (IHC, n= 31) and western blot (n= 3). Retrospective studies were designed to determine the clinical parameters and the total survival rate, and correlation between the protein expression levels of the most significant key genes and prognosis was analyzed. RESULTS: In total, 668 genes were upregulated and 869 genes were downregulated in SNMM (fold change ⩾ 2, adjusted p value < 0.01). Both mRNA and protein expression levels of the key genes in SNMM tumor tissues were higher than those in the normal control nasal mucosal tissues. The expression rates of TYRP1, ABCB5, and MMP17 in 31 primary SNMM cases were 90.32%, 80.65%, and 64.52%, respectively. In addition, age, typical symptoms, and AJCC stage were related to overall survival rate of patients with SNMM (p< 0.05). Furthermore, the expression of ABCB5 was age-related (p= 0.002). Compared with individuals with negative ABCB5 expression, those with positive expression exhibited significantly poor overall survival (p= 0.02). CONCLUSION: The expression levels of TYRP1, ABCB5, and MMP17 were significantly upregulated in SNMM tissues, and the expression of ABCB5 was related to poor prognosis in SNMM. Thus, ABCB5 may serve as a progression marker and can predict unfavorable prognosis in patients with SNMM.
Collapse
Affiliation(s)
- Junhao Tu
- Department of Otorhinolaryngology, Head and Neck Surgery, The First Affiliated Hospital of Nanchang University, Nanchang, Jiangxi, China
- Department of Otorhinolaryngology, Head and Neck Surgery, The First Affiliated Hospital of Nanchang University, Nanchang, Jiangxi, China
| | - Jun Wang
- Department of Otorhinolaryngology, Head and Neck Surgery, The First Affiliated Hospital of Nanchang University, Nanchang, Jiangxi, China
- Department of Otorhinolaryngology, Head and Neck Surgery, The First Affiliated Hospital of Nanchang University, Nanchang, Jiangxi, China
| | - Binxiang Tang
- Department of Otorhinolaryngology, Head and Neck Surgery, The First Affiliated Hospital of Nanchang University, Nanchang, Jiangxi, China
| | - Zhiqiang Zhang
- Department of Otorhinolaryngology, Head and Neck Surgery, The First Affiliated Hospital of Nanchang University, Nanchang, Jiangxi, China
| | - Mei Han
- Department of Otorhinolaryngology, Head and Neck Surgery, The First Affiliated Hospital of Nanchang University, Nanchang, Jiangxi, China
| | - Mengyue Li
- Department of Otorhinolaryngology, Head and Neck Surgery, The First Affiliated Hospital of Nanchang University, Nanchang, Jiangxi, China
| | - Jieqing Yu
- Department of Otorhinolaryngology, Head and Neck Surgery, The First Affiliated Hospital of Nanchang University, Nanchang, Jiangxi, China
- Institute of Otorhinolaryngology, The First Affiliated Hospital of Nanchang University, Nanchang, Jiangxi, China
| | - Li Shen
- Department of Otorhinolaryngology, Head and Neck Surgery, The First Affiliated Hospital of Nanchang University, Nanchang, Jiangxi, China
| | - Meiping Zhang
- Department of Otorhinolaryngology, Head and Neck Surgery, The First Affiliated Hospital of Nanchang University, Nanchang, Jiangxi, China
| | - Jing Ye
- Department of Otorhinolaryngology, Head and Neck Surgery, The First Affiliated Hospital of Nanchang University, Nanchang, Jiangxi, China
- Institute of Otorhinolaryngology, The First Affiliated Hospital of Nanchang University, Nanchang, Jiangxi, China
| |
Collapse
|
11
|
Rojas-Lechuga MJ, Gras-Cabrerizo JR, Aviles-Jurado FX, Malvehy J, Arance AM, Castillo P, Barreiro A, Podlipnik S, Lopez-Chacon M, Alobid I, Bernal-Sprekelsen M, Puig S, Langdon C. Sinonasal mucosal melanomas: defining profiles for better survival outcomes. Rhinology 2022; 60:347-356. [PMID: 36184882 DOI: 10.4193/rhin21.251] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND Sinonasal mucosal melanoma is an aggressive malignancy with a 5-year survival rate ranging from 20% to 39%. Despite the evolving surgical and radiotherapy techniques, and introduction of immune-checkpoint inhibitor therapy, overall survival rates remain poor. METHODOLOGY A retrospective cohort study was conducted at the Hospital Clinic de Barcelona and the Hospital de la Santa Creu i Sant Pau between 1984 and 2020; primary outcome measures were 3 and 5-year melanoma-specific survival (MSS). Kaplan-Meier survival analysis and Cox proportional hazards model were performed to identify predictors of survival. RESULTS Fifty patients were included, the mean age was 70.4, MSS at 3 and 5 years was 51.2%, and 29.5%, respectively. The median follow-up was 39.6 months during which 46% presented locoregional recurrence and 36%, metastasis. The univariate and multivariate analyses found as survival predictors the N category, the treatment received, the surgical margins and the mitotic index. CONCLUSIONS We found an overall 5-year MSS of 29.5%. Those patients with intention-to-cure (stages III and IVa) treated by surgery that were N0 at diagnosis, with < 10 mitoses per HPF showed a 5-year MSS rate of 74.1%. More studies will be needed to adequately define the patients' profiles that will benefit from a better survival outcome.
Collapse
Affiliation(s)
- M J Rojas-Lechuga
- Otorhinolaryngology Department, Hospital Clinic de Barcelona, IDIBAPS, University of Barcelona, Barcelona, Spain
| | - J R Gras-Cabrerizo
- Otorhinolaryngology Head-Neck Surgery Department, Hospital de la Santa Creu i Sant Pau, Universitat Autonoma de Barcelona, Barcelona, Spain
| | - F X Aviles-Jurado
- Otorhinolaryngology Department, Hospital Clinic de Barcelona, IDIBAPS, University of Barcelona, Barcelona, Spain
- Head Neck Clínic, University and Research Grants Management Agency (AGAUR), 2017-SGR-01581
- and Center for Biomedical Research Network on Diabetes and Metabolic Diseases (CIBERDEM), Barcelona, Spain
| | - J Malvehy
- Melanoma Unit, Department of Dermatology, Hospital Clinic de Barcelona, IDIBAPS, Centre of Biomedical Research on Rare Diseases (CIBERER), ISCIII, Barcelona, Spain
| | - A M Arance
- Oncology Department, Hospital Clinic de Barcelona, IDIBAPS, Barcelona, Spain
| | - P Castillo
- Pathology Department, Hospital Clinic de Barcelona, IDIBAPS, Barcelona, Spain
| | - A Barreiro
- Melanoma Unit, Department of Dermatology, Hospital Clinic de Barcelona, IDIBAPS, Centre of Biomedical Research on Rare Diseases (CIBERER), ISCIII, Barcelona, Spain
| | - S Podlipnik
- Melanoma Unit, Department of Dermatology, Hospital Clinic de Barcelona, IDIBAPS, Centre of Biomedical Research on Rare Diseases (CIBERER), ISCIII, Barcelona, Spain
| | - M Lopez-Chacon
- Otorhinolaryngology Department, Hospital Clinic de Barcelona, IDIBAPS, University of Barcelona, Barcelona, Spain
| | - I Alobid
- Otorhinolaryngology Department, Hospital Clinic de Barcelona, IDIBAPS, University of Barcelona, Barcelona, Spain
| | - M Bernal-Sprekelsen
- Otorhinolaryngology Department, Hospital Clinic de Barcelona, IDIBAPS, University of Barcelona, Barcelona, Spain
| | - S Puig
- Melanoma Unit, Department of Dermatology, Hospital Clinic de Barcelona, IDIBAPS, Centre of Biomedical Research on Rare Diseases (CIBERER), ISCIII, Barcelona, Spain
| | - C Langdon
- Otorhinolaryngology Department, Hospital Clinic de Barcelona, IDIBAPS, University of Barcelona, Barcelona, Spain
| |
Collapse
|
12
|
Arosio AD, Bernasconi DP, Valsecchi MG, Pacifico C, Battaglia P, Bignami M, Ferrari M, Mattavelli D, Rampinelli V, Tomasoni M, Schreiber A, Gualtieri T, Piazza C, Magrini SM, Tartaro T, Molteni M, Lambertoni A, Sileo G, Bossi P, Orlandi E, Bertazzoni G, Fiaux-Camous D, Jourdaine C, Verillaud B, Herman P, Nicolai P, Castelnuovo P, Turri-Zanoni M. Patterns of recurrences in sinonasal cancers undergoing an endoscopic surgery-based treatment: Results of the MUSES* on 940 patients: *MUlti-institutional collaborative Study on Endoscopically treated Sinonasal cancers. Oral Oncol 2022; 134:106123. [PMID: 36174456 DOI: 10.1016/j.oraloncology.2022.106123] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2022] [Revised: 07/18/2022] [Accepted: 09/04/2022] [Indexed: 11/15/2022]
Abstract
OBJECTIVES The improvements in survival with expansion of the survivors' population, along with evolution of endoscopically-based treatment modalities, have contributed to emphasize the clinical relevance of recurrences in sinonasal cancers. However, at present, literature is scant regarding the pattern of recurrences and the therapeutic strategies available to manage long survivors who experienced single or multiple failures. The aim of the present study was to analyze sinonasal cancers recurrences to provide data regarding rates and patterns of relapse, predictors of failure and prognostic impact of the recurrence. MATERIALS AND METHODS All patients receiving multimodal treatments including endoscopic surgery between 1995 and 2021 in three European referral centers were included. Statistical analysis of survival was performed through univariable, multivariable and unidirectional multistate models. Survival after recurrence analysis was implemented for patients experiencing at least one recurrence. RESULTS The 5- and 10-year recurrence free survival rates were 34.1% and 38.4% for the whole population. With a mean follow-up time of 60 months, a global recurrence rate of 32.9% was observed. The 5- and 10-year survival after recurrence rates were 27.2% and 21.7%, respectively. Incidence and rates of recurrences were significantly associated with histology subtypes. CONCLUSION This study provides valuable oncologic outcomes regarding a large homogenous cohort of patients affected by sinonasal malignances treated within a multimodal framework, emphasizing the strong correlation of histologic type with prognosis, as well as with pattern of recurrences.
Collapse
Affiliation(s)
- Alberto Daniele Arosio
- Division of Otorhinolaryngology, Department of Surgical Specialties, "ASST Sette Laghi, Ospedale di Circolo e Fondazione Macchi", Varese, Italy.
| | - Davide Paolo Bernasconi
- Bicocca Bioinformatics Biostatistics and Bioimaging Centre - B4, School of Medicine and Surgery, University of Milano-Bicocca, Monza, Italy
| | - Maria Grazia Valsecchi
- Bicocca Bioinformatics Biostatistics and Bioimaging Centre - B4, School of Medicine and Surgery, University of Milano-Bicocca, Monza, Italy
| | - Claudia Pacifico
- Bicocca Bioinformatics Biostatistics and Bioimaging Centre - B4, School of Medicine and Surgery, University of Milano-Bicocca, Monza, Italy
| | - Paolo Battaglia
- Division of Otorhinolaryngology, Department of Surgical Specialties, "ASST Sette Laghi, Ospedale di Circolo e Fondazione Macchi", Varese, Italy; Division of Otorhinolaryngology, Department of Biotechnology and Life Sciences, "ASST Sette Laghi, Ospedale di Circolo e Fondazione Macchi", University of Insubria, Varese, Italy; Head and Neck Surgery & Forensic Dissection Research Center (HNS&FDRc), Department of Biotechnology and Life Sciences, University of Insubria, Varese, Italy
| | - Maurizio Bignami
- Head and Neck Surgery & Forensic Dissection Research Center (HNS&FDRc), Department of Biotechnology and Life Sciences, University of Insubria, Varese, Italy; Division of Otorhinolaryngology, "ASST Lariana", University of Insubria, Como, Italy
| | - Marco Ferrari
- Unit of Otorhinolaryngology - Head and Neck Surgery, Department of Neurosciences, "Azienda Ospedale Università di Padova", University of Padua, Padua, Italy; Guided Therapeutics (GTx) Program International Scholarship, University Health Network (UHN), Toronto, ON, Canada; Technology for Health (Program), Department of Information Engineering, University of Brescia, Brescia, Italy
| | - Davide Mattavelli
- Unit of Otorhinolaryngology - Head and Neck Surgery, Department of Medical and Surgical Specialties, Radiologic Sciences, and Public Health, "ASST Spedali Civili di Brescia", University of Brescia, Brescia, Italy
| | - Vittorio Rampinelli
- Technology for Health (Program), Department of Information Engineering, University of Brescia, Brescia, Italy; Unit of Otorhinolaryngology - Head and Neck Surgery, Department of Medical and Surgical Specialties, Radiologic Sciences, and Public Health, "ASST Spedali Civili di Brescia", University of Brescia, Brescia, Italy
| | - Michele Tomasoni
- Unit of Otorhinolaryngology - Head and Neck Surgery, Department of Medical and Surgical Specialties, Radiologic Sciences, and Public Health, "ASST Spedali Civili di Brescia", University of Brescia, Brescia, Italy
| | - Alberto Schreiber
- Unit of Otorhinolaryngology - Head and Neck Surgery, Department of Medical and Surgical Specialties, Radiologic Sciences, and Public Health, "ASST Spedali Civili di Brescia", University of Brescia, Brescia, Italy
| | - Tommaso Gualtieri
- Unit of Otorhinolaryngology - Head and Neck Surgery, Department of Medical and Surgical Specialties, Radiologic Sciences, and Public Health, "ASST Spedali Civili di Brescia", University of Brescia, Brescia, Italy
| | - Cesare Piazza
- Unit of Otorhinolaryngology - Head and Neck Surgery, Department of Medical and Surgical Specialties, Radiologic Sciences, and Public Health, "ASST Spedali Civili di Brescia", University of Brescia, Brescia, Italy
| | - Stefano Maria Magrini
- Unit of Radiation Oncology, Department of Medical and Surgical Specialties, Radiologic Sciences, and Public Health, "ASST Spedali Civili di Brescia", University of Brescia, Brescia, Italy
| | - Tiziana Tartaro
- Department of Medical Oncology, "ASST Sette Laghi, Ospedale di Circolo e Fondazione Macchi", Varese, Italy
| | - Marinella Molteni
- Department of Radiotherapy, "ASST Sette Laghi, Ospedale di Circolo e Fondazione Macchi", Varese, Italy
| | - Alessia Lambertoni
- Division of Otorhinolaryngology, Department of Surgical Specialties, "ASST Sette Laghi, Ospedale di Circolo e Fondazione Macchi", Varese, Italy
| | - Giorgio Sileo
- Division of Otorhinolaryngology, Department of Surgical Specialties, "ASST Sette Laghi, Ospedale di Circolo e Fondazione Macchi", Varese, Italy
| | - Paolo Bossi
- Unit of Medical Oncology, Department of Medical and Surgical Specialties, Radiologic Sciences, and Public Health, "ASST Spedali Civili di Brescia", University of Brescia, Brescia, Italy
| | - Ester Orlandi
- Radiation Oncology Clinical Department, National Center for Oncological Hadrontherapy (CNAO), Pavia, Italy
| | | | | | - Clement Jourdaine
- Department of Otorhinolaryngology, Lariboisière University Hospital, Paris, France
| | - Benjamin Verillaud
- Department of Otorhinolaryngology, Lariboisière University Hospital, Paris, France
| | - Philippe Herman
- Department of Otorhinolaryngology, Lariboisière University Hospital, Paris, France
| | - Piero Nicolai
- Unit of Otorhinolaryngology - Head and Neck Surgery, Department of Neurosciences, "Azienda Ospedale Università di Padova", University of Padua, Padua, Italy
| | - Paolo Castelnuovo
- Division of Otorhinolaryngology, Department of Surgical Specialties, "ASST Sette Laghi, Ospedale di Circolo e Fondazione Macchi", Varese, Italy; Division of Otorhinolaryngology, Department of Biotechnology and Life Sciences, "ASST Sette Laghi, Ospedale di Circolo e Fondazione Macchi", University of Insubria, Varese, Italy; Head and Neck Surgery & Forensic Dissection Research Center (HNS&FDRc), Department of Biotechnology and Life Sciences, University of Insubria, Varese, Italy
| | - Mario Turri-Zanoni
- Division of Otorhinolaryngology, Department of Surgical Specialties, "ASST Sette Laghi, Ospedale di Circolo e Fondazione Macchi", Varese, Italy; Division of Otorhinolaryngology, Department of Biotechnology and Life Sciences, "ASST Sette Laghi, Ospedale di Circolo e Fondazione Macchi", University of Insubria, Varese, Italy; Head and Neck Surgery & Forensic Dissection Research Center (HNS&FDRc), Department of Biotechnology and Life Sciences, University of Insubria, Varese, Italy
| |
Collapse
|
13
|
Ferrari M, Mattavelli D, Tomasoni M, Raffetti E, Bossi P, Schreiber A, Orlandi E, Taboni S, Rampinelli V, Gualtieri T, Turri-Zanoni M, Battaglia P, Arosio AD, Bignami M, Tartaro T, Molteni M, Bertazzoni G, Fiaux-Camous D, Jourdaine C, Verillaud B, Eu D, Nair D, Moiyadi A, Shetty P, Ghosh-Laskar S, Budrukkar A, Magrini SM, Guillerm S, Faivre S, Piazza C, Gilbert RW, Irish JC, de Almeida JR, Pai P, Herman P, Castelnuovo P, Nicolai P. The MUSES∗: a prognostic study on 1360 patients with sinonasal cancer undergoing endoscopic surgery-based treatment: ∗MUlti-institutional collaborative Study on Endoscopically treated Sinonasal cancers. Eur J Cancer 2022; 171:161-182. [PMID: 35724468 DOI: 10.1016/j.ejca.2022.05.010] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2022] [Revised: 05/04/2022] [Accepted: 05/15/2022] [Indexed: 11/17/2022]
Abstract
BACKGROUND Over the last 2 decades, transnasal endoscopic surgery (TES) has become the most frequently employed surgical technique to treat sinonasal malignancies. The rarity and heterogeneity of sinonasal cancers have hampered large non-population-based analyses. METHODOLOGY All patients receiving TES-including treatment between 1995 and 2021 in 5 referral hospitals were included. A prognostic study was performed, and multivariable models were transformed into nomograms. Training and validation sets were based on results from 3 European and 2 non-European centres, respectively. RESULTS The training and validation set included 940 and 420 patients, respectively. The mean age at surgery, primary-versus-recurrent presentation, histology distribution, type of surgery, T category and type of adjuvant treatment were differently distributed in the training and validation set. In the training set, 5-year overall survival and recurrence-free survival with a 95%-confidence interval were 72.7% (69.5-76.0%) and 66.4% (63.1-69.8%), respectively, significantly varying with histology. At multivariable analyses, age, gender, previous treatment, the extent of resection on the cranial, lateral and posterolateral axes, grade/subtype, T category, nodal status, margin status and adjuvant treatment were all associated with different prognostic outcomes, displaying a heterogeneous significance and effect size according to histology. The internal and external validation of nomograms was satisfactory (optimism-corrected C-index >0.7 and cumulative area under curve >0.7) for all histologies but mucosal melanoma. CONCLUSIONS Outcomes of TES-based treatment of sinonasal cancers vary substantially with histology. This large, non-population-based study provides benchmark data on the prognosis of sinonasal cancers that are deemed suitable for treatment including TES.
Collapse
Affiliation(s)
- Marco Ferrari
- Unit of Otorhinolaryngology - Head and Neck Surgery, Department of Neurosciences, "Azienda Ospedale Università di Padova", University of Padua, Padua, Italy; Guided Therapeutics (GTx) Program International Scholarship, University Health Network (UHN), Toronto, ON, Canada; Technology for Health (PhD Program), Department of Information Engineering, University of Brescia, Brescia, Italy.
| | - Davide Mattavelli
- Unit of Otorhinolaryngology - Head and Neck Surgery, Department of Medical and Surgical Specialties, Radiologic Sciences, and Public Health, "ASST Spedali Civili di Brescia", University of Brescia, Brescia, Italy
| | - Michele Tomasoni
- Unit of Otorhinolaryngology - Head and Neck Surgery, Department of Medical and Surgical Specialties, Radiologic Sciences, and Public Health, "ASST Spedali Civili di Brescia", University of Brescia, Brescia, Italy
| | - Elena Raffetti
- Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden
| | - Paolo Bossi
- Unit of Medical Oncology, Department of Medical and Surgical Specialties, Radiologic Sciences, and Public Health, "ASST Spedali Civili di Brescia", University of Brescia, Brescia, Italy
| | - Alberto Schreiber
- Unit of Otorhinolaryngology - Head and Neck Surgery, Department of Medical and Surgical Specialties, Radiologic Sciences, and Public Health, "ASST Spedali Civili di Brescia", University of Brescia, Brescia, Italy
| | - Ester Orlandi
- Radiation Oncology Clinical Department, National Center for Oncological Hadrontherapy (CNAO), Pavia, Italy
| | - Stefano Taboni
- Unit of Otorhinolaryngology - Head and Neck Surgery, Department of Neurosciences, "Azienda Ospedale Università di Padova", University of Padua, Padua, Italy; Guided Therapeutics (GTx) Program International Scholarship, University Health Network (UHN), Toronto, ON, Canada; Artificial Intelligence in Medicine and Innovation in Clinical Research and Methodology (PhD Program), Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy
| | - Vittorio Rampinelli
- Technology for Health (PhD Program), Department of Information Engineering, University of Brescia, Brescia, Italy; Unit of Otorhinolaryngology - Head and Neck Surgery, Department of Medical and Surgical Specialties, Radiologic Sciences, and Public Health, "ASST Spedali Civili di Brescia", University of Brescia, Brescia, Italy
| | - Tommaso Gualtieri
- Unit of Otorhinolaryngology - Head and Neck Surgery, Department of Medical and Surgical Specialties, Radiologic Sciences, and Public Health, "ASST Spedali Civili di Brescia", University of Brescia, Brescia, Italy
| | - Mario Turri-Zanoni
- Division of Otorhinolaryngology, Department of Surgical Specialties, "ASST Sette Laghi, Ospedale di Circolo e Fondazione Macchi", Varese, Italy; Division of Otorhinolaryngology, Department of Biotechnology and Life Sciences, University of Insubria, Varese, Italy; Head and Neck Surgery & Forensic Dissection Research Center (HNS&FDRc), Department of Biotechnology and Life Sciences, University of Insubria, Varese, Italy
| | - Paolo Battaglia
- Division of Otorhinolaryngology, Department of Surgical Specialties, "ASST Sette Laghi, Ospedale di Circolo e Fondazione Macchi", Varese, Italy; Division of Otorhinolaryngology, Department of Biotechnology and Life Sciences, University of Insubria, Varese, Italy; Head and Neck Surgery & Forensic Dissection Research Center (HNS&FDRc), Department of Biotechnology and Life Sciences, University of Insubria, Varese, Italy
| | - Alberto D Arosio
- Division of Otorhinolaryngology, Department of Surgical Specialties, "ASST Sette Laghi, Ospedale di Circolo e Fondazione Macchi", Varese, Italy
| | - Maurizio Bignami
- Division of Otorhinolaryngology, "ASST Lariana", University of Insubria, Como, Italy
| | - Tiziana Tartaro
- Department of Medical Oncology, "ASST Sette Laghi, Ospedale di Circolo e Fondazione Macchi", Varese, Italy
| | - Marinella Molteni
- Department of Radiotherapy, "ASST Sette Laghi, Ospedale di Circolo e Fondazione Macchi", Varese, Italy
| | | | | | - Clement Jourdaine
- Hopital Lariboisiere, APHP Nord - Université De Paris, INSERM U 1141, Paris, France
| | - Benjamin Verillaud
- Hopital Lariboisiere, APHP Nord - Université De Paris, INSERM U 1141, Paris, France
| | - Donovan Eu
- Department of Otolaryngology - Head and Neck Surgery/Surgical Oncology, University Health Network, Toronto, Ontario, Canada; Guided Therapeutics (GTx) Program, Techna Institute, University Health Network, Toronto, Ontario, Canada
| | - Deepa Nair
- Department of Head & Neck Surgery, Tata Memorial Hospital and Homi Bhabha National Institute, Mumbai, India
| | - Aliasgar Moiyadi
- Department of Neurosurgery, Tata Memorial Hospital and Homi Bhabha National Institute, Mumbai, India
| | - Prakash Shetty
- Department of Neurosurgery, Tata Memorial Hospital and Homi Bhabha National Institute, Mumbai, India
| | - Sarbani Ghosh-Laskar
- Department of Radiation Oncology, Tata Memorial Hospital and Homi Bhabha National Institute, Mumbai, India
| | - Ashwini Budrukkar
- Department of Radiation Oncology, Tata Memorial Hospital and Homi Bhabha National Institute, Mumbai, India
| | - Stefano M Magrini
- Unit of Radiation Oncology, Department of Medical and Surgical Specialties, Radiologic Sciences, and Public Health, "ASST Spedali Civili di Brescia", University of Brescia, Brescia, Italy
| | - Sophie Guillerm
- Department of Radiotherapy Assistance Publique - Hôpitaux de Paris, Hôpital Saint-Louis, Paris, France
| | - Sandrine Faivre
- Department of Medical Oncology Assistance Publique - Hôpitaux de Paris, Hôpital Saint Louis, Université de Paris, Paris, France
| | - Cesare Piazza
- Unit of Otorhinolaryngology - Head and Neck Surgery, Department of Medical and Surgical Specialties, Radiologic Sciences, and Public Health, "ASST Spedali Civili di Brescia", University of Brescia, Brescia, Italy
| | - Ralph W Gilbert
- Department of Otolaryngology - Head and Neck Surgery/Surgical Oncology, University Health Network, Toronto, Ontario, Canada
| | - Jonathan C Irish
- Department of Otolaryngology - Head and Neck Surgery/Surgical Oncology, University Health Network, Toronto, Ontario, Canada; Guided Therapeutics (GTx) Program, Techna Institute, University Health Network, Toronto, Ontario, Canada
| | - John R de Almeida
- Department of Otolaryngology - Head and Neck Surgery/Surgical Oncology, University Health Network, Toronto, Ontario, Canada
| | - Prathamesh Pai
- Department of Head & Neck Surgery, Tata Memorial Hospital and Homi Bhabha National Institute, Mumbai, India
| | - Philippe Herman
- Hopital Lariboisiere, APHP Nord - Université De Paris, INSERM U 1141, Paris, France
| | - Paolo Castelnuovo
- Division of Otorhinolaryngology, Department of Surgical Specialties, "ASST Sette Laghi, Ospedale di Circolo e Fondazione Macchi", Varese, Italy; Division of Otorhinolaryngology, Department of Biotechnology and Life Sciences, University of Insubria, Varese, Italy; Head and Neck Surgery & Forensic Dissection Research Center (HNS&FDRc), Department of Biotechnology and Life Sciences, University of Insubria, Varese, Italy
| | - Piero Nicolai
- Unit of Otorhinolaryngology - Head and Neck Surgery, Department of Neurosciences, "Azienda Ospedale Università di Padova", University of Padua, Padua, Italy
| |
Collapse
|
14
|
Zhang S, Zhang J, Guo J, Si L, Bai X. Evolving Treatment Approaches to Mucosal Melanoma. Curr Oncol Rep 2022; 24:1261-1271. [PMID: 35511393 DOI: 10.1007/s11912-022-01225-z] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/08/2021] [Indexed: 12/19/2022]
Abstract
PURPOSE OF REVIEW This review mainly focuses on the unique features and the development of available therapeutic options for mucosal melanoma in different treatment settings, i.e., neoadjuvant, adjuvant, and palliative. RECENT FINDINGS Mucosal melanoma is distinct from cutaneous melanoma in epidemiology, clinical features, and molecular landscape, characterized by more aggressive biological behavior, lower mutational burden, more chromosomal structure variants, unique driver mutation profile, and distinct tumor microenvironment. Systemic therapy is generally less effective to mucosal melanoma than its cutaneous counterpart. Therapeutic landscape for mucosal melanoma has evolved substantially in recent years: with new targeted therapy options as well as combination therapies built on the backbone of anti-PD-1/PD-L1 antibodies available (esp. anti-angiogenic agent and PD-1/PD-L1 combination), which, based on early phase trial data, seem to be promising. Mucosal melanoma is unique and distinct from cutaneous subtype. Unraveling the unique features of mucosal melanoma is a key to improve clinical outcomes.
Collapse
Affiliation(s)
- Shuai Zhang
- Department of Melanoma and Sarcoma, Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education, Beijing), Peking University Cancer Hospital and Institute, No. 52 Fucheng Road, Haidian District, Beijing, 100142, China
| | - Jiaran Zhang
- Department of Melanoma and Sarcoma, Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education, Beijing), Peking University Cancer Hospital and Institute, No. 52 Fucheng Road, Haidian District, Beijing, 100142, China
| | - Jun Guo
- Department of Melanoma and Sarcoma, Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education, Beijing), Peking University Cancer Hospital and Institute, No. 52 Fucheng Road, Haidian District, Beijing, 100142, China
| | - Lu Si
- Department of Melanoma and Sarcoma, Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education, Beijing), Peking University Cancer Hospital and Institute, No. 52 Fucheng Road, Haidian District, Beijing, 100142, China.
| | - Xue Bai
- Department of Melanoma and Sarcoma, Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education, Beijing), Peking University Cancer Hospital and Institute, No. 52 Fucheng Road, Haidian District, Beijing, 100142, China.
| |
Collapse
|
15
|
Young K, Arkfeld DV, Squires LD. Temporal bone mucosal melanoma masquerading as otomastoiditis. OTOLARYNGOLOGY CASE REPORTS 2022. [DOI: 10.1016/j.xocr.2022.100438] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
|
16
|
Nenclares P, Harrington KJ. Management of Head and Neck Mucosal Melanoma. Oral Maxillofac Surg Clin North Am 2022; 34:299-314. [DOI: 10.1016/j.coms.2021.11.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
|
17
|
Lu Z, Zhou Y, Nie G, Miao B, Lu Y, Chen T. Prognostic Nomograms for Predicting Overall Survival and Cancer-Specific Survival in Patients with Head and Neck Mucosal Melanoma. Int J Gen Med 2022; 15:2759-2771. [PMID: 35300129 PMCID: PMC8922241 DOI: 10.2147/ijgm.s352701] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2021] [Accepted: 02/25/2022] [Indexed: 11/23/2022] Open
Affiliation(s)
- Zhenzhang Lu
- Department of Otorhinolaryngology, The First Affiliated Hospital of Shenzhen University/Shenzhen Second People’s Hospital, Shenzhen, Guangdong Province, 518000, People’s Republic of China
- Department of Otorhinolaryngology, South China Hospital of Shenzhen University, Shenzhen, Guangdong Province, 518000, People’s Republic of China
| | - Yuxiang Zhou
- Department of Otorhinolaryngology, People’s Hospital of Shenzhen Baoan District, Shenzhen, Guangdong Province, 518000, People’s Republic of China
| | - Guohui Nie
- Department of Otorhinolaryngology, The First Affiliated Hospital of Shenzhen University/Shenzhen Second People’s Hospital, Shenzhen, Guangdong Province, 518000, People’s Republic of China
| | - Beiping Miao
- Department of Otorhinolaryngology, The First Affiliated Hospital of Shenzhen University/Shenzhen Second People’s Hospital, Shenzhen, Guangdong Province, 518000, People’s Republic of China
| | - Yongtian Lu
- Department of Otorhinolaryngology, The First Affiliated Hospital of Shenzhen University/Shenzhen Second People’s Hospital, Shenzhen, Guangdong Province, 518000, People’s Republic of China
| | - Tao Chen
- Department of Otorhinolaryngology, The First Affiliated Hospital of Shenzhen University/Shenzhen Second People’s Hospital, Shenzhen, Guangdong Province, 518000, People’s Republic of China
- Correspondence: Tao Chen, Department of Otorhinolaryngology, The First Affiliated Hospital of Shenzhen University/Shenzhen Second People’s Hospital, No. 3002 Sungang West Road, Shenzhen, Guangdong Province, 518000, People’s Republic of China, Tel +86755-83366388, Email
| |
Collapse
|
18
|
Yin G, Guo W, Huang Z, Chen X. Comparative analysis of postoperative adjuvant therapy for head and neck mucosal melanoma in China. Acta Otolaryngol 2021; 141:1014-1021. [PMID: 34766867 DOI: 10.1080/00016489.2021.1921263] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
BACKGROUND Head and neck mucosal melanoma is a rare malignant disease with no clear and effective treatment to control the prognosis of patients. AIM To analyze the effects of different postoperative adjuvant treatments on the survival and prognosis of patients. MATERIAL AND METHODS A retrospective analysis of 163 patients which were divided into five groups: no adjuvant therapy, postoperative radiotherapy, postoperative chemotherapy, postoperative chemotherapy and radiotherapy, and postoperative immunotherapy. Kaplan-Meier method and Cox regression analysis were used to analyze the prognosis in the different groups. RESULTS Postoperative radiotherapy had statistically significant effects on local recurrence, distant metastasis, overall survival, progression-free survival (PFS) and recurrence-free survival (RFS); Postoperative chemotherapy and postoperative chemotherapy/radiotherapy had effects on distant metastasis, overall survival, PFS and RFS. However, postoperative immunotherapy did not show any significant effects. For patients with limited lesions who underwent endoscopic surgery, receive postoperative radiotherapy and postoperative chemotherapy/radiotherapy seem to have better prognosis. CONCLUSIONS AND SIGNIFICANCE For the head and neck mucosal melanoma, different types adjuvant therapy can prolong the survival of patients to varying degrees compared with no postoperative treatment, but immunotherapy as a single adjuvant therapy does not show any advantages. We recommended that patients should receive radiotherapy and/or chemotherapy after surgery.
Collapse
Affiliation(s)
- Gaofei Yin
- Beijing Tongren Hospital, Capital Medical University, Beijing, China
| | - Wei Guo
- Beijing Tongren Hospital, Capital Medical University, Beijing, China
| | - Zhigang Huang
- Beijing Tongren Hospital, Capital Medical University, Beijing, China
| | - Xiaohong Chen
- Beijing Tongren Hospital, Capital Medical University, Beijing, China
| |
Collapse
|
19
|
Abstract
Mucosal melanoma is a rare but aggressive cancer arising in mucosal surfaces most commonly in the head and neck. The clinical presentation is often nonspecific and differs in relation to the site of origin so often diagnosis is delayed resulting in poor prognosis. Mucosal melanoma has a 5-year survival of only 25%. Surgery with negative margins is the mainstay of treatment but dependent on several variables including anatomic location, involved structures, and size of tumor. Although not well defined given the rarity of mucosal melanoma, there is a role for radiation and systemic therapy in the treatment of this disease.
Collapse
Affiliation(s)
- Danielle Olla
- Institute for Plastic Surgery, Southern Illinois University, 747 N Rutledge Street #3, Springfield, IL 62702, USA.
| | - Michael W Neumeister
- Department of Surgery, The Elvin G Zook Endowed Chair - Institute for Plastic Surgery, Southern Illinois University, 747 N Rutledge Street #3, Springfield, IL 62702, USA
| |
Collapse
|
20
|
Edmond M, Nenclares P, Harrington K, Ap Dafydd D, Bagwan I, Begg D, Lingley K, Patterson G, Payne M, Steven N, Turnbull N, Yip K, Silva P, Kerawala C, Paleri V, King E. What is the role of the surgeon in the management of head and neck mucosal melanoma in the immunotherapy era? Head Neck 2021; 43:3498-3503. [PMID: 34453460 DOI: 10.1002/hed.26849] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2021] [Revised: 07/14/2021] [Accepted: 08/17/2021] [Indexed: 12/13/2022] Open
Abstract
INTRODUCTION The advent of immunotherapy has impacted both the management and, to a lesser extent, the outcomes for patients with head and neck mucosal melanoma. As a consequence, one might expect that the role of the surgeon would be limited to the diagnostic work-up and that systemic therapies would be the mainstay of treatment. METHODS AND RESULTS Here, we present the surgical aspects of the recently published United Kingdom Head and Neck Mucosal Melanoma Guideline to highlight the continued role of surgeons in the management of this disease. We highlight key areas where surgeons remain the lead clinician and reinforce the multidisciplinary requirement for exemplary patient care. CONCLUSIONS Despite the advent of immunotherapy, surgeons continue to have a key role to play in this disease. When indicated, it is essential that appropriate surgery is offered by a suitably experienced team.
Collapse
Affiliation(s)
- Mark Edmond
- University Hospitals Dorset NHS Foundation Trust, UK.,Cancer Sciences Division, University of Southampton, UK
| | | | - Kevin Harrington
- Royal Marsden NHS Foundation Trust, UK.,Institute of Cancer Research, UK
| | | | | | - Donna Begg
- University Hospitals Birmingham NHS Foundation Trust, UK
| | | | | | - Miranda Payne
- Oxford University Hospitals NHS Foundation Trust, UK
| | - Neil Steven
- University Hospitals Birmingham NHS Foundation Trust, UK
| | | | - Kent Yip
- East Sussex and North Essex NHS Foundation Trust, UK
| | | | | | | | - Emma King
- University Hospitals Dorset NHS Foundation Trust, UK.,Cancer Sciences Division, University of Southampton, UK
| |
Collapse
|
21
|
Ledderose S, Ledderose C, Penkava J, Ledderose GJ. Prognostic Value of Tumor-Infiltrating Lymphocytes in Sinonasal Mucosal Melanoma. Laryngoscope 2021; 132:1334-1339. [PMID: 34415055 DOI: 10.1002/lary.29820] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2021] [Accepted: 08/06/2021] [Indexed: 12/19/2022]
Abstract
OBJECTIVES/HYPOTHESIS Tumor-infiltrating lymphocytes (TILs) predict better outcome in several types of cancers. However, the prognostic value of TILs in sinonasal mucosal melanoma (SNMM) is uncertain. Here, we investigated whether TILs can be used as a prognostic indicator for survival in SNMM. STUDY DESIGN Retrospective cohort study. METHODS Patient history and histologic specimens from 27 patients with primary SNMM were retrospectively analyzed. TIL grade was determined and associations between TILs and AJCC tumor stage, overall survival, and recurrence-free survival were analyzed. RESULTS Patients with TILs in the primary tumor classified as brisk or non-brisk survived significantly longer than patients with SNMMs lacking lymphocyte infiltrates. Brisk TILs were associated with the lower T3 stage and increased recurrence-free and 5-year survival. CONCLUSION Our results indicate that TIL density is a strong prognostic factor for better survival in SNMM. Prospective studies with larger case numbers are warranted to determine whether TILs should be included in future AJCC staging guidelines. LEVEL OF EVIDENCE 3 Laryngoscope, 2021.
Collapse
Affiliation(s)
- Stephan Ledderose
- Department of Pathology, Ludwig Maximilian University of Munich, Munich, Germany
| | - Carola Ledderose
- Department of Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, U.S.A
| | - Josef Penkava
- Department of Ophthalmology, Technical University of Munich, Munich, Germany
| | - Georg J Ledderose
- Department of Otorhinolaryngology, Head and Neck Surgery, Ludwig Maximilian University of Munich, Munich, Germany.,ENT-Center Dr. Lübbers & Kollegen, Weilheim, Germany
| |
Collapse
|
22
|
Abstract
Noncutaneous melanomas are rare subtypes of melanoma with high rates of metastatic disease and poor overall survival. One-third to one-half of cases are amelanotic, which may contribute to a delay in diagnosis. Immunohistochemistry staining with typical melanoma markers helps confirm the diagnosis. There is no standard staging system across mucosal melanomas. Elective nodal dissection is not recommended and there is a paucity of data to support use of sentinel lymph node biopsy. Mutational analysis should be routinely performed. Systemic therapy options include targeted inhibitors, immunotherapy, and cytotoxic chemotherapy, although further studies are needed to confirm their efficacy.
Collapse
Affiliation(s)
- Ann Y Lee
- Department of Surgery, NYU Langone Health, 550 1st Avenue, NBV 15N1, New York, NY 10016, USA.
| | - Russell S Berman
- Department of Surgery, NYU Langone Health, 550 1st Avenue, NBV 15N1, New York, NY 10016, USA. https://twitter.com/bermar01
| |
Collapse
|
23
|
Abiri A, Yasaka TM, Lehrich BM, Goshtasbi K, Papagiannopoulos P, Tajudeen BA, St John MA, Harris JP, Kuan EC. Adjuvant Therapy and Prognosticators of Survival in Head and Neck Mucosal Melanoma. Laryngoscope 2021; 132:584-592. [PMID: 34355791 DOI: 10.1002/lary.29807] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2021] [Revised: 06/22/2021] [Accepted: 07/19/2021] [Indexed: 11/09/2022]
Abstract
OBJECTIVES/HYPOTHESIS To identify prognosticators and determine the efficacies of surgery with adjuvant radiotherapy (SR) and surgery with immunotherapy (SI) of head and neck mucosal melanoma (HNMM). STUDY DESIGN Retrospective database study. METHODS The 2004 to 2017 National Cancer Database was queried for HNMM patients. Cox proportional hazards and Kaplan-Meier analyses evaluated prognosticators of mortality and survival benefits conferred by SR, SI, or surgery with adjuvant radiotherapy and immunotherapy (SRI). Logistic regression identified predictors of adjuvant radiotherapy or immunotherapy use. RESULTS Overall, 1,910 cases (845 surgery, 802 SR, 51 SI, 101 SRI) were analyzed, with 50.3% females and an average age of 68.6 ± 13.8 years. SI was associated with greater overall survival (OS) than surgery (hazard ratio [HR] 0.672; P = .036). SI (HR 0.425; P = .024) and SRI (HR 0.594; P = .045) were associated with superior OS than SR. Older age (HR 1.607; P < .001), female sex (HR 0.757; P = .006), paranasal sinus localization (HR 1.648; P < .001), T4 classification (HR 1.443; P < .001), N1 classification (HR 2.310; P < .001), M1 classification (HR 3.357; P < .001), and positive surgical margins (HR 1.454; P < .001) were survival prognosticators. Adjuvant radiotherapy use was negatively correlated with older age, oral cavity localization, and M0 or T3 tumors (all P < .05). Adjuvant immunotherapy use was positively correlated with younger age and M1 tumors (all P < .05). CONCLUSIONS Although SR did not confer survival benefits in HNMM patients, SI and SRI yielded greater OS than surgery alone. SRI was associated with superior survival outcomes than SR. Certain demographic and clinical factors were associated with increased mortality risk. Patient age and certain tumor characteristics were predictors of adjuvant radiotherapy or immunotherapy use. LEVEL OF EVIDENCE 4 Laryngoscope, 2021.
Collapse
Affiliation(s)
- Arash Abiri
- Department of Otolaryngology-Head and Neck Surgery, University of California, Irvine, California, U.S.A
| | - Tyler M Yasaka
- Department of Otolaryngology-Head and Neck Surgery, University of California, Irvine, California, U.S.A
| | - Brandon M Lehrich
- Department of Otolaryngology-Head and Neck Surgery, University of California, Irvine, California, U.S.A
| | - Khodayar Goshtasbi
- Department of Otolaryngology-Head and Neck Surgery, University of California, Irvine, California, U.S.A
| | - Peter Papagiannopoulos
- Department of Otolaryngology-Head and Neck Surgery, Rush University Medical Center, Chicago, Illinois, U.S.A
| | - Bobby A Tajudeen
- Department of Otolaryngology-Head and Neck Surgery, Rush University Medical Center, Chicago, Illinois, U.S.A
| | - Maie A St John
- Department of Head and Neck Surgery, University of California, Los Angeles, Los Angeles, California, U.S.A
| | - Jeremy P Harris
- Department of Radiation Oncology, University of California, Irvine, California, U.S.A
| | - Edward C Kuan
- Department of Otolaryngology-Head and Neck Surgery, University of California, Irvine, California, U.S.A
| |
Collapse
|
24
|
Xu QQ, Lai YZ, Huang ZL, Zeng ZY, Zhang YN, Ou RY, Wu WM, Chen L, Lu LX. Clinical outcomes and patterns of failure of head and neck mucosal melanoma treated with multiple treatment modalities. Radiat Oncol 2021; 16:138. [PMID: 34321026 PMCID: PMC8317323 DOI: 10.1186/s13014-021-01860-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2021] [Accepted: 07/14/2021] [Indexed: 02/03/2023] Open
Abstract
OBJECTIVES The study aims to analyze the clinical characteristics of head and neck mucosal melanoma (MMHN) and the effects of multiple treatment modalities on distant metastasis, recurrence and survival rates to provide a reference for the individualized treatment of MMHN. METHODS We retrospectively reviewed 262 patients with stage III-IVb MMHN treated from March 1986 to November 2018 at our cancer center. RESULTS The median follow-up time was 34.0 months (range 1-262 months). The 5-year overall survival (OS), distant metastasis-free survival (DMFS) and disease-free survival (DFS) probabilities were 37.7%, 30.2%, and 20.3%, respectively. The 5-year OS rates for patients with stage III, stage IVA, and stage IVB MMHN were 67.0%, 24.1% and 8.3%, respectively (P < 0.001). A total of 246 (93.9%) patients received surgery, 149 (56.9%) patients received chemotherapy, and 69 (26.3%) patients received immunologic/targeted therapy. A total of 106 (40.5%) patients were treated with radiotherapy: 9 were treated with preoperative radiotherapy, 93 were treated with postoperative radiotherapy, and 4 were treated with radiotherapy alone. In the multivariate Cox regression analysis, primary tumor site, T stage, and immunologic/targeted therapy were independent factors for OS (all P < 0.05). Irradiation technique, T stage, and N stage were independent prognostic factors for DMFS (all P < 0.05). T stage, N stage, and surgery were independent prognostic factors for DFS (all P < 0.05). Distant metastasis was observed in 107 of 262 patients (40.8%), followed by local [74 (28.2%)] and regional [52 (19.8%)] recurrence. CONCLUSIONS The main reason for treatment failure in MMHN is distant metastasis. Immunologic/targeted therapy and surgery are recommended to improve the survival of MMHN. The American Joint Committee on Cancer (AJCC) 8th edition staging system for MMHN does stage this disease effectively.
Collapse
Affiliation(s)
- Qing-Qing Xu
- Department of Radiation Oncology, Sun Yat-Sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine,, Guangdong Key Laboratory of Nasopharyngeal Carcinoma Diagnosis and Therapy, 651 Dongfeng Road East, Guangzhou, 510060, China
| | - Yan-Zhen Lai
- Department of Radiation Oncology, Sun Yat-Sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine,, Guangdong Key Laboratory of Nasopharyngeal Carcinoma Diagnosis and Therapy, 651 Dongfeng Road East, Guangzhou, 510060, China.,Heyuan People's Hospital, Heyuan, China
| | - Zi-Lu Huang
- Department of Radiation Oncology, Sun Yat-Sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine,, Guangdong Key Laboratory of Nasopharyngeal Carcinoma Diagnosis and Therapy, 651 Dongfeng Road East, Guangzhou, 510060, China
| | - Zi-Yi Zeng
- Department of Radiation Oncology, Sun Yat-Sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine,, Guangdong Key Laboratory of Nasopharyngeal Carcinoma Diagnosis and Therapy, 651 Dongfeng Road East, Guangzhou, 510060, China
| | - Ya-Ni Zhang
- Department of Radiation Oncology, Sun Yat-Sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine,, Guangdong Key Laboratory of Nasopharyngeal Carcinoma Diagnosis and Therapy, 651 Dongfeng Road East, Guangzhou, 510060, China
| | - Rui-Yao Ou
- Department of Radiation Oncology, Sun Yat-Sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine,, Guangdong Key Laboratory of Nasopharyngeal Carcinoma Diagnosis and Therapy, 651 Dongfeng Road East, Guangzhou, 510060, China
| | - Wen-Min Wu
- Department of Radiation Oncology, Sun Yat-Sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine,, Guangdong Key Laboratory of Nasopharyngeal Carcinoma Diagnosis and Therapy, 651 Dongfeng Road East, Guangzhou, 510060, China
| | - Lei Chen
- Department of Radiation Oncology, Sun Yat-Sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine,, Guangdong Key Laboratory of Nasopharyngeal Carcinoma Diagnosis and Therapy, 651 Dongfeng Road East, Guangzhou, 510060, China.
| | - Li-Xia Lu
- Department of Radiation Oncology, Sun Yat-Sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine,, Guangdong Key Laboratory of Nasopharyngeal Carcinoma Diagnosis and Therapy, 651 Dongfeng Road East, Guangzhou, 510060, China.
| |
Collapse
|
25
|
Sahovaler A, Ziai H, Cardemil F, Huang SH, Su J, Goldstein DP, Gilbert R, Hosni A, Hope A, Waldron J, Spreafico A, Monteiro E, Witterick I, Irish J, Gullane P, Xu W, O'Sullivan B, de Almeida JR. Importance of Margins, Radiotherapy, and Systemic Therapy in Mucosal Melanoma of the Head and Neck. Laryngoscope 2021; 131:2269-2276. [PMID: 33856051 DOI: 10.1002/lary.29555] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2021] [Accepted: 03/30/2021] [Indexed: 12/18/2022]
Abstract
OBJECTIVES/HYPOTHESIS The ideal strategy in the treatment of mucosal melanoma of the head and neck (MMHN) remains unclear. Our objective was to evaluate the importance of surgical margins, radiotherapy, and systemic therapy in MMHN. STUDY DESIGN Retrospective Single Institutional Review. METHODS Retrospective review of patients with MMHN treated at a tertiary care oncology center between 1999 and 2016. RESULTS Seventy-six patients were included, 60 of whom were treated with curative intent. Negative or close margins compared with positive margins were associated with higher 3-year overall survival (OS) (62% vs. 29% vs. 13% P = .012), disease-free survival (33% vs. 29% vs. 4% P = .003), and distant control (48% vs. 29% vs. 22% P = .039). Cases with pre-/postoperative radiotherapy had a marginally higher locoregional control versus without (69% vs. 59%, P = .117). Immunotherapy for recurrent and/or metastatic disease was associated with an increase in 3-year OS (15% vs. 3% P = .01). CONCLUSION Achieving negative surgical margins is relevant in disease control. Despite small sample size, our data suggest that radiotherapy may enhance surgical outcomes. Immunotherapy has therapeutic benefit. LEVEL OF EVIDENCE 3 Laryngoscope, 2021.
Collapse
Affiliation(s)
- Axel Sahovaler
- Department of Otolaryngology-Head and Neck Surgery, Princess Margaret Cancer Centre, University of Toronto, Toronto, Ontario, Canada
| | - Hedyeh Ziai
- Department of Otolaryngology-Head and Neck Surgery, Princess Margaret Cancer Centre, University of Toronto, Toronto, Ontario, Canada
| | - Felipe Cardemil
- Department of Otolaryngology-Head and Neck Surgery, Princess Margaret Cancer Centre, University of Toronto, Toronto, Ontario, Canada
| | - Shao Hui Huang
- Department of Otolaryngology-Head and Neck Surgery, Princess Margaret Cancer Centre, University of Toronto, Toronto, Ontario, Canada.,Department of Radiation Oncology, Princess Margaret Cancer Centre, University of Toronto, Toronto, Ontario, Canada
| | - Jie Su
- Department of Biostatistics, Princess Margaret Cancer Centre, University of Toronto, Toronto, Ontario, Canada
| | - David P Goldstein
- Department of Otolaryngology-Head and Neck Surgery, Princess Margaret Cancer Centre, University of Toronto, Toronto, Ontario, Canada
| | - Ralph Gilbert
- Department of Otolaryngology-Head and Neck Surgery, Princess Margaret Cancer Centre, University of Toronto, Toronto, Ontario, Canada
| | - Ali Hosni
- Department of Radiation Oncology, Princess Margaret Cancer Centre, University of Toronto, Toronto, Ontario, Canada
| | - Andrew Hope
- Department of Radiation Oncology, Princess Margaret Cancer Centre, University of Toronto, Toronto, Ontario, Canada
| | - John Waldron
- Department of Otolaryngology-Head and Neck Surgery, Princess Margaret Cancer Centre, University of Toronto, Toronto, Ontario, Canada.,Department of Radiation Oncology, Princess Margaret Cancer Centre, University of Toronto, Toronto, Ontario, Canada
| | - Anna Spreafico
- Division of Medical Oncology and Hematology, Princess Margaret Cancer Centre, University of Toronto, Toronto, Ontario, Canada
| | - Eric Monteiro
- Department of Otolaryngology-Head and Neck Surgery, Sinai Health System, University of Toronto, Toronto, Ontario, Canada
| | - Ian Witterick
- Department of Otolaryngology-Head and Neck Surgery, Sinai Health System, University of Toronto, Toronto, Ontario, Canada
| | - Jonathan Irish
- Department of Otolaryngology-Head and Neck Surgery, Princess Margaret Cancer Centre, University of Toronto, Toronto, Ontario, Canada
| | - Patrick Gullane
- Department of Otolaryngology-Head and Neck Surgery, Princess Margaret Cancer Centre, University of Toronto, Toronto, Ontario, Canada
| | - Wei Xu
- Department of Biostatistics, Princess Margaret Cancer Centre, University of Toronto, Toronto, Ontario, Canada
| | - Brian O'Sullivan
- Department of Otolaryngology-Head and Neck Surgery, Princess Margaret Cancer Centre, University of Toronto, Toronto, Ontario, Canada.,Department of Radiation Oncology, Princess Margaret Cancer Centre, University of Toronto, Toronto, Ontario, Canada
| | - John R de Almeida
- Department of Otolaryngology-Head and Neck Surgery, Princess Margaret Cancer Centre, University of Toronto, Toronto, Ontario, Canada
| |
Collapse
|
26
|
Sinonasal mucosal melanoma: treatment strategies and survival rates for a rare disease entity : A single center experience and review of literature. Wien Klin Wochenschr 2021; 133:1137-1147. [PMID: 33844113 PMCID: PMC8599389 DOI: 10.1007/s00508-021-01847-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2020] [Accepted: 03/03/2021] [Indexed: 12/13/2022]
Abstract
Background Sinonasal mucosal melanoma (SNMM) is a rare disease entity comprising 0.4–1.3% of all melanomas. Surgery with free margins has been the primary treatment over decades. Neither the addition of radiotherapy nor chemotherapy could significantly improve outcome rates of this devastating malignancy. This study presents our clinical experience with SNMM over a 19-year period and summarizes the current body of literature on SNMM. Methods This retrospective analysis included 12 patients with SNMM treated from 2001 to 2019 at an academic center. Additionally, a literature review of the last 29 years on treatment and survival data of SNMM was conducted. Results Main initial symptoms were epistaxis and nasal obstruction. Of the patients 9 underwent endoscopic surgery, 6 received adjuvant therapy. 3 patients who did not undergo surgery, received chemoradiotherapy, radiotherapy alone, and chemotherapy alone, respectively. At the time of diagnosis 2 patients had distant metastases and 4 patients developed distant metastases during the course of the disease. Mean overall survival (OS) was 30.6 months, 3‑year and 5‑year OS were 25%, and 18.2%, respectively. Conclusion Unspecific symptoms and hidden anatomic locations lead to delayed diagnosis and increased rates of metastatic dissemination. Distant metastasis is the main treatment failure in SNMM. Surgery with free margins remains the primary treatment for SNMM. Adjuvant radiotherapy might improve local control in individual cases but efficient systemic therapy is needed to improve outcome rates. To evaluate and define more effective targeted treatment options and improve outcome rates, homogeneous data and prospective multicentric analysis are needed.
Collapse
|
27
|
Grant‐Freemantle MC, Lane O'Neill B, Clover AJP. The effectiveness of radiotherapy in the treatment of head and neck mucosal melanoma: Systematic review and meta‐analysis. Head Neck 2020; 43:323-333. [DOI: 10.1002/hed.26470] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2020] [Revised: 08/30/2020] [Accepted: 09/04/2020] [Indexed: 12/23/2022] Open
Affiliation(s)
| | | | - Anthony James P. Clover
- School of Medicine University College Cork Cork Ireland
- Department of Plastic Surgery Cork University Hospital Cork Ireland
| |
Collapse
|
28
|
Nenclares P, Ap Dafydd D, Bagwan I, Begg D, Kerawala C, King E, Lingley K, Paleri V, Paterson G, Payne M, Silva P, Steven N, Turnbull N, Yip K, Harrington KJ. Head and neck mucosal melanoma: The United Kingdom national guidelines. Eur J Cancer 2020; 138:11-18. [PMID: 32829104 DOI: 10.1016/j.ejca.2020.07.017] [Citation(s) in RCA: 29] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2020] [Revised: 07/03/2020] [Accepted: 07/19/2020] [Indexed: 01/10/2023]
Abstract
The United Kingdom head and neck mucosal melanoma guideline development group used an evidence-based systematic approach to make recommendations in key areas of uncertainty in the field, including accurate diagnosis and staging; the appropriate treatment pathway including surgery, adjuvant radiation and new systemic treatments, such as targeted agents and immunotherapy; and the surveillance of patients after treatment. The guidelines were sent for international peer review and have been accredited by the National Institute for Health and Care Excellence. A summary of key recommendations is presented. The full documents are available on the Melanoma Focus website (https://melanomafocus.com/activities/mucosal-guidelines/mucosal-melanoma-resources/).
Collapse
Affiliation(s)
| | | | - Izhar Bagwan
- Royal Surrey County Hospital NHS Foundation Trust, Surrey, UK
| | - Donna Begg
- University Hospitals Birmingham, Birmingham, UK
| | | | - Emma King
- Poole Hospital NHS Foundation Trust, Dorset, UK
| | | | - Vinidh Paleri
- Royal Marsden Hospital NHS Foundation Trust, London, UK; The Institute of Cancer Research, London, UK
| | | | - Miranda Payne
- Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - Priyamal Silva
- Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - Neil Steven
- University Hospitals Birmingham, Birmingham, UK
| | | | - Kent Yip
- East Suffolk and North Essex NHS Foundation Trust, UK
| | - Kevin J Harrington
- Royal Marsden Hospital NHS Foundation Trust, London, UK; The Institute of Cancer Research, London, UK
| |
Collapse
|
29
|
Wang T, Huang Y, Lu J, Xiang M. Sinonasal mucosal melanoma: a 10-year experience of 36 cases in China. ANNALS OF TRANSLATIONAL MEDICINE 2020; 8:1022. [PMID: 32953822 PMCID: PMC7475479 DOI: 10.21037/atm-20-5575] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
Background Sinonasal mucosal melanoma (SNMM) is a rare tumor with a poor prognosis. This study aimed to assess the clinical and imaging features, progression, treatment, and possible prognostic factors of SNMM. Methods Thirty-six patients with SNMM were retrospectively reviewed in the Department of Otolaryngology & Head and Neck Surgery of Xinhua Hospital from January 2008 to December 2017. Results The age of the first diagnosis was 67.4±10.8 years; the most common clinical symptoms included epistaxis, nasal obstruction, headache, and facial pain. Most tumors originated in the nasal cavity (63.9%) and at stage IV (77.8%). Melanin in melanoma showed typical signal intensity on magnetic resonance imaging (MRI), T1WI had high signal while T2WI had low signal. 41.6% of patients had the typical MRI findings. Treatment included surgery, surgery with radiotherapy, and radiotherapy only. The follow-up time ranged from 4 to 96 months, with a median time of 22 months, 1-, 3-, and 5-year OS is 80.6%, 36.1%, and 13.9%, respectively. The 3-year OS was better in cases in the T3 stage than the T4 stage (P=0.02). However, tumors that originated from the paranasal sinus had a poorer prognosis than the nasal cavity (P=0.04). The cases receiving postoperative radiotherapy showed poorer prognosis (P=0.02). Other factors were not found to be associated with prognosis, including gender, age, lymph node metastasis, distant metastasis, computed tomography (CT) enhancement, and typical MRI findings. Conclusions The SNMM was a devastating tumor with poor outcomes; most cases were diagnosed at late stages, which may account for poor prognosis. Tumors with melanin feature MRI findings do not have a better prognosis. The treatment of postoperative radiotherapy is still controversial.
Collapse
Affiliation(s)
- Tan Wang
- Department of Otorhinolaryngology, Head and Neck Surgery, Xinhua Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China.,Ear Institute, Shanghai Jiaotong University School of Medicine, Shanghai, China.,Shanghai Key Laboratory of Translational Medicine on Ear and Nose diseases, Shanghai, China
| | - Yue Huang
- Department of Otorhinolaryngology, Head and Neck Surgery, Xinhua Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China.,Ear Institute, Shanghai Jiaotong University School of Medicine, Shanghai, China.,Shanghai Key Laboratory of Translational Medicine on Ear and Nose diseases, Shanghai, China
| | - Jingrong Lu
- Department of Otorhinolaryngology, Head and Neck Surgery, Xinhua Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China.,Ear Institute, Shanghai Jiaotong University School of Medicine, Shanghai, China.,Shanghai Key Laboratory of Translational Medicine on Ear and Nose diseases, Shanghai, China
| | - Mingliang Xiang
- Ear Institute, Shanghai Jiaotong University School of Medicine, Shanghai, China.,Shanghai Key Laboratory of Translational Medicine on Ear and Nose diseases, Shanghai, China.,Department of Otorhinolaryngology, Head and Neck Surgery, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China
| |
Collapse
|
30
|
Na'ara S, Mukherjee A, Billan S, Gil Z. Contemporary Multidisciplinary Management of Sinonasal Mucosal Melanoma. Onco Targets Ther 2020; 13:2289-2298. [PMID: 32214828 PMCID: PMC7083634 DOI: 10.2147/ott.s182580] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2019] [Accepted: 02/12/2020] [Indexed: 12/31/2022] Open
Abstract
Sinonasal mucosal melanoma (SNMM) is a rare tumor, comprising less than 10% of sinonasal malignancies. SNMM most frequently occurs in the nasal cavity (70%) and maxillary sinus (14%), typically as black patches. Overall, SNMM harbors a very poor prognosis; 5-year survival is less than 30%. Nasal cavity tumors confer a better prognosis than sinus melanoma. The primary management for SNMM is surgery, when feasible, followed by adjuvant radiotherapy. Recent studies suggest that immunotherapy may confer survival benefit to patients with advanced disease. The multidisciplinary team approach has been shown to optimize treatment, reduce costs, and minimize adverse events, while maximizing the chances for cure.
Collapse
Affiliation(s)
- Shorook Na'ara
- The Laboratory for Applied Cancer Research, Department of Otolaryngology Head and Neck Surgery, Technion-Israel Institute of Technology, Rambam Healthcare Campus, Haifa, Israel.,The Head and Neck Center, Rambam Healthcare Campus, Clinical Research Institute at Rambam, Rappaport Institute of Medicine and Research, Technion-Israel Institute of Technology, Haifa, Israel
| | - Abhishek Mukherjee
- Department of Genetics and Developmental Biology, Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel
| | - Salem Billan
- The Head and Neck Center, Rambam Healthcare Campus, Clinical Research Institute at Rambam, Rappaport Institute of Medicine and Research, Technion-Israel Institute of Technology, Haifa, Israel.,The Oncology Institute, Rambam Health Care Campus, Haifa, Israel
| | - Ziv Gil
- The Laboratory for Applied Cancer Research, Department of Otolaryngology Head and Neck Surgery, Technion-Israel Institute of Technology, Rambam Healthcare Campus, Haifa, Israel.,The Head and Neck Center, Rambam Healthcare Campus, Clinical Research Institute at Rambam, Rappaport Institute of Medicine and Research, Technion-Israel Institute of Technology, Haifa, Israel
| |
Collapse
|
31
|
Appelbaum EN, Gross ND, Diab A, Bishop AJ, Nader ME, Gidley PW. Melanoma of the External Auditory Canal: A Review of Seven Cases at a Tertiary Care Referral Center. Laryngoscope 2020; 131:165-172. [PMID: 32065414 DOI: 10.1002/lary.28548] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2019] [Revised: 12/23/2019] [Accepted: 01/16/2020] [Indexed: 01/31/2023]
Abstract
OBJECTIVES/HYPOTHESIS Examine the presentation and management characteristics of seven patients with melanoma of the external auditory canal (EAC). STUDY DESIGN Retrospective case series and review of the relevant literature. METHODS Records of seven patients from 2003 to 2017 with melanoma of the EAC were reviewed for characteristics of presentation, subsequent management, and outcomes. A thorough review of relevant literature is presented. RESULTS The median age is 52 years, with four females. The average Breslow depth was 3.6 mm, with five patients having a Clark level IV or greater on presentation. Six patients underwent lateral temporal bone resection, and one patient underwent wide local excision of the cartilaginous canal. Sentinel lymph node biopsy (SLNB) was performed in three patients. Three patients experienced distant recurrence an average of 20 months following primary therapy. Median follow-up was 21 months. At last follow-up, four were free of disease, one had active disease, and two were deceased from melanoma. CONCLUSIONS This is the largest series and the first to report the use of SLNB for patients with EAC melanoma in the peer-reviewed literature. Patients with external auditory canal melanoma present with higher Breslow thickness and stage relative to all external ear melanomas. Management should include wide local excision, which entails lateral temporal bone resection when the bony ear canal is involved. SLNB has a critical role in identifying patients with early metastatic disease. Postoperative radiation therapy should be considered for patients with high-risk features to reduce the risk of locoregional relapse. Chemotherapy, and especially immunotherapy, has an emerging role for this disease. LEVEL OF EVIDENCE 4 Laryngoscope, 131:165-172, 2021.
Collapse
Affiliation(s)
- Eric N Appelbaum
- Department of Head and Neck Surgery, University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Neil D Gross
- Department of Head and Neck Surgery, University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Adi Diab
- Department of Melanoma Medical Oncology, University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Andrew J Bishop
- Department of Radiation Oncology, University of Texas MD Anderson Cancer Center, Houston, Texas, U.S.A
| | - Marc-Elie Nader
- Department of Head and Neck Surgery, University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Paul W Gidley
- Department of Head and Neck Surgery, University of Texas MD Anderson Cancer Center, Houston, Texas
| |
Collapse
|
32
|
Hafström A, Brun E, Persson S, Sjövall J, Wahlberg P, Greiff L. Survival benefits from concomitant chemoradiotherapy before radical surgery in stage IVA sinonasal mucosal melanoma? Laryngoscope Investig Otolaryngol 2019; 4:624-631. [PMID: 31890880 PMCID: PMC6929603 DOI: 10.1002/lio2.317] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2019] [Revised: 08/31/2019] [Accepted: 09/18/2019] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND The aim of the study was to review a local treatment protocol for sinonasal mucosal melanoma (SNMM) focusing on triple modality treatment (TMT), that is, neoadjuvant concomitant chemoradiotherapy (CRT) and surgery. METHODS In a retrospective design, data on clinical presentation, treatment, and survival were retrieved for 22 consecutive patients from a tertiary referral center. RESULTS The mean overall survival (OS) for all patients (3 stage III, 16 stage IVA, and 3 stage IVB) was 62 months, and the 5-year OS rate 50%. Four of the 22 patients received treatment with palliative intention. Of the 18 patients who received treatment with curative intention, patients with stage IVA disease who received TMT (n = 10) had a 5-year OS of 70% and 10-year OS of 20%. The median disease-free survival for these patients was 51 months compared with 9 months for stage IVA not receiving TMT (n = 4). CONCLUSION A seemingly favorable survival outcome for a disease with characteristically poor prognosis was observed. The lead finding was a high survival rate (70% 5-year OS) for stage IVA patients who received neoadjuvant TMT. The observations suggest the possibility that patients with advanced SNMM (stage IVA) might benefit from concomitant CRT before surgery by delaying the onset of local recurrences and distant metastases. LEVEL OF EVIDENCE Level 4, case series (with or without comparison).
Collapse
Affiliation(s)
- Anna Hafström
- Department of ORL, Head & Neck SurgerySkåne University HospitalLundSweden
- Department of Clinical SciencesLund UniversityLundSweden
| | - Eva Brun
- Department of Clinical SciencesLund UniversityLundSweden
- Department of OncologySkåne University HospitalLundSweden
| | - Simon Persson
- Department of Clinical SciencesLund UniversityLundSweden
| | - Johanna Sjövall
- Department of ORL, Head & Neck SurgerySkåne University HospitalLundSweden
- Department of Clinical SciencesLund UniversityLundSweden
| | - Peter Wahlberg
- Department of ORL, Head & Neck SurgerySkåne University HospitalLundSweden
- Department of Clinical SciencesLund UniversityLundSweden
| | - Lennart Greiff
- Department of ORL, Head & Neck SurgerySkåne University HospitalLundSweden
- Department of Clinical SciencesLund UniversityLundSweden
| |
Collapse
|
33
|
Prinzen T, Klein M, Hallermann C, Wermker K. Primary head and neck mucosal melanoma: Predictors of survival and a case series on sentinel node biopsy. J Craniomaxillofac Surg 2019; 47:1370-1377. [DOI: 10.1016/j.jcms.2019.06.012] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2019] [Revised: 06/12/2019] [Accepted: 06/19/2019] [Indexed: 02/03/2023] Open
|
34
|
Misra R, Sarkar K, Lee J, Pizzuti VJ, Lee DS, Currie MP, Torregrosa-Allen SE, Long DE, Durm GA, Langer MP, Elzey BD, Won YY. Radioluminescent nanoparticles for radiation-controlled release of drugs. J Control Release 2019; 303:237-252. [PMID: 31026550 DOI: 10.1016/j.jconrel.2019.04.033] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2018] [Revised: 04/10/2019] [Accepted: 04/22/2019] [Indexed: 01/03/2023]
Abstract
The present work demonstrates a novel concept for intratumoral chemo-radio combination therapy for locally advanced solid tumors. For some locally advanced tumors, chemoradiation is currently standard of care. This combination treatment can cause acute and long term toxicity that can limit its use in older patients or those with multiple medical comorbidities. Intratumoral chemotherapy has the potential to address the problem of systemic toxicity that conventional chemotherapy suffers, and may, in our view, be a better strategy for treating certain locally advanced tumors. The present study proposes how intratumoral chemoradiation can be best implemented. The enabling concept is the use of a new chemotherapeutic formulation in which chemotherapy drugs (e.g., paclitaxel (PTX)) are co-encapsulated with radioluminecsnt nanoparticles (e.g., CaWO4 (CWO) nanoparticles (NPs)) within protective capsules formed by biocompatible/biodegradable polymers (e.g., poly(ethylene glycol)-poly(lactic acid) or PEG-PLA). This drug-loaded polymer-encapsulated radioluminescent nanoparticle system can be locally injected in solution form into the patient's tumor before the patient receives normal radiotherapy (e.g., 30-40 fractions of 2-3 Gy daily X-ray dose delivered over several weeks for locally advanced head and neck tumors). Under X-ray irradiation, the radioluminescent nanoparticles produce UV-A light that has a radio-sensitizing effect. These co-encapsulated radioluminescent nanoparticles also enable radiation-triggered release of chemo drugs from the polymer coating layer. The non-toxic nature (absence of dark toxicity) of this drug-loaded polymer-encapsulated radioluminescent nanoparticle ("PEG-PLA/CWO/PTX") formulation was confirmed by the MTT assay in cancer cell cultures. A clonogenic cell survival assay confirmed that these drug-loaded polymer-encapsulated radioluminescent nanoparticles significantly enhance the cancer cell killing effect of radiation therapy. In vivo study validated the efficacy of PEG-PLA/CWO/PTX-based intratumoral chemo-radio therapy in mouse tumor xenografts (in terms of tumor response and mouse survival). Results of a small-scale NP biodistribution (BD) study demonstrate that PEG-PLA/CWO/PTX NPs remained at the tumor sites for a long period of time (> 1 month) following direct intratumoral administration. A multi-compartmental pharmacokinetic model (with rate constants estimated from in vitro experiments) predicts that this radiation-controlled drug release technology enables significant improvements in the level and duration of drug availability within the tumor (throughout the typical length of radiation treatment, i.e., > 1 month) over conventional delivery systems (e.g., PEG-PLA micelles with no co-encapsulated CaWO4, or an organic liquid, e.g., a 50:50 mixture of Cremophor EL and ethanol, as in Taxol), while it is capable of maintaining the systemic level of the chemo drug far below the toxic threshold limit over the entire treatment period. This technology thus has the potential to offer a new therapeutic option that has not previously been available for patients excluded from conventional chemoradiation protocols.
Collapse
Affiliation(s)
- Rahul Misra
- Davidson School of Chemical Engineering, Purdue University, West Lafayette, IN 47907, United States
| | - Kaustabh Sarkar
- Davidson School of Chemical Engineering, Purdue University, West Lafayette, IN 47907, United States
| | - Jaewon Lee
- Davidson School of Chemical Engineering, Purdue University, West Lafayette, IN 47907, United States
| | - Vincenzo J Pizzuti
- Davidson School of Chemical Engineering, Purdue University, West Lafayette, IN 47907, United States
| | - Deborah S Lee
- Davidson School of Chemical Engineering, Purdue University, West Lafayette, IN 47907, United States
| | - Melanie P Currie
- Purdue University Center for Cancer Research, Purdue University, West Lafayette, IN 47907, United States
| | - Sandra E Torregrosa-Allen
- Purdue University Center for Cancer Research, Purdue University, West Lafayette, IN 47907, United States
| | - David E Long
- Department of Radiation Oncology, Indiana University School of Medicine, Indianapolis, IN 46202, United States
| | - Gregory A Durm
- Department of Medicine, Indiana University School of Medicine, Indianapolis, IN 46202, United States
| | - Mark P Langer
- Department of Radiation Oncology, Indiana University School of Medicine, Indianapolis, IN 46202, United States
| | - Bennett D Elzey
- Purdue University Center for Cancer Research, Purdue University, West Lafayette, IN 47907, United States
| | - You-Yeon Won
- Davidson School of Chemical Engineering, Purdue University, West Lafayette, IN 47907, United States; Purdue University Center for Cancer Research, Purdue University, West Lafayette, IN 47907, United States.
| |
Collapse
|
35
|
Current concepts in advanced sinonasal mucosal melanoma: a single institution experience. Eur Arch Otorhinolaryngol 2019; 276:2259-2265. [PMID: 31098872 DOI: 10.1007/s00405-019-05458-w] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2019] [Accepted: 04/30/2019] [Indexed: 02/07/2023]
Abstract
PURPOSE To present outcome measures of sinonasal mucosal melanoma (SMM) patients with particular focus on current radiological and therapeutic options, especially in the non-curative setting (immunotherapy). METHODS Retrospective study on SMM patients treated at our institution between January 1992 and December 2018. RESULTS FDG-PET/MRI has emerged as the new hybrid imaging modality, addressing the need for high local tissue contrast in the paranasal sinuses and the skull base, while allowing for whole-body staging in search for distant metastases, including the brain. Primary treatment protocols consisted of tumor resection in 30/34 patients (88%), palliative radiation therapy (RT) in 3/34 patients (9%) and best supportive care therapy in 1/34 patient (3%). Of all the initially operated patients, 25/30 patients (83%) received adjuvant RT. A total of 9/34 patients (26%) was treated with immunotherapy after the previous combined therapy. For patients treated in curative intention, we observed a 1-year overall survival (OS) of 60% (18/30 patients) and a 3-year OS of 40% (12/30 patients). For patients treated with immunotherapy, median progression-free survival (PFS) was 5 months (IQR 0-13.75), with a maximum PFS of 16 months (combination of nivolumab and ipilimumab). However, there was no difference in OS in patients treated with immunotherapy vs. no immunotherapy (log rank 0.99). CONCLUSIONS Sinonasal mucosal melanoma is a highly aggressive tumor, requiring multimodal therapy and developing a substantial incidence of distant metastases. The introduction of FDG-PET/MRI offers new possibilities in the radiological assessment of the tumor and immunotherapy has altered the management in the non-curative setting, resulting in a substantial progression-free survival in selected cases.
Collapse
|
36
|
Ganti A, Raman A, Shay A, Kuhar HN, Auger SR, Patel T, Kuan EC, Diaz AZ, Batra PS, Tajudeen BA. Treatment modalities in sinonasal mucosal melanoma: A national cancer database analysis. Laryngoscope 2019; 130:275-282. [PMID: 31021415 DOI: 10.1002/lary.27995] [Citation(s) in RCA: 34] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2019] [Revised: 03/14/2019] [Accepted: 03/25/2019] [Indexed: 12/21/2022]
Abstract
OBJECTIVES/HYPOTHESIS The purpose of this study was to investigate the association of demographic factors, tumor stage, and treatment modalities for overall survival in patients with sinonasal mucosal melanoma (SNMM). STUDY DESIGN Retrospective database review. METHODS The National Cancer Database was queried for patients of all ages with SNMM between 2004 and 2015. Univariate Kaplan-Meier and multivariate Cox regression analyses were performed to evaluate the association of suspected prognostic factors with overall survival. RESULTS A total of 1,874 patients with SNMM were included in the analysis. The 5-year overall survival was 24%. Prognostic factors associated with decreased survival include advanced age (hazard ratio [HR]: 1.02, 95% confidence interval [CI]: 1.01-1.03), T4 disease (HR: 1.44, 95% CI: 1.09-1.89), and presence of distant metastases (HR: 3.22. 95% CI: 2.06-5.04). Improved survival was associated with surgical resection only when margins were negative (HR: 0.44; 95% CI: 0.30-0.65). In patients with metastatic disease, administration of immunotherapy (HR: 0.14; 95% CI: 0.04-0.49) was associated with improved survival. Surgical approach, radiotherapy, and chemotherapy were nonsignificant predictors of survival. CONCLUSIONS This investigation is the largest to date to analyze the association of treatment modalities with overall survival in SNMM. Surgery remains the mainstay of treatment in patients with SNMM. However, administration of immunotherapy may confer survival benefit to patients with metastatic disease. LEVEL OF EVIDENCE NA Laryngoscope, 130:275-282, 2020.
Collapse
Affiliation(s)
- Ashwin Ganti
- Rush Medical College, Rush University Medical Center, Chicago, Illinois, U.S.A
| | - Anish Raman
- Rush Medical College, Rush University Medical Center, Chicago, Illinois, U.S.A
| | - Aryan Shay
- Rush Medical College, Rush University Medical Center, Chicago, Illinois, U.S.A
| | - Hannah N Kuhar
- Rush Medical College, Rush University Medical Center, Chicago, Illinois, U.S.A
| | - Samuel R Auger
- Rush Medical College, Rush University Medical Center, Chicago, Illinois, U.S.A
| | - Tirth Patel
- Department of Otorhinolaryngology-Head and Neck Surgery, Rush Center for Skull Base and Pituitary Surgery, Rush University Medical Center, Chicago, Illinois, U.S.A
| | - Edward C Kuan
- Department of Otolaryngology-Head and Neck Surgery, University of California, Irvine Medical Center, Orange, California, U.S.A
| | - Aidnag Z Diaz
- and Department of Radiation Oncology, Rush University Medical Center, Chicago, Illinois, U.S.A
| | - Pete S Batra
- Department of Otorhinolaryngology-Head and Neck Surgery, Rush Center for Skull Base and Pituitary Surgery, Rush University Medical Center, Chicago, Illinois, U.S.A
| | - Bobby A Tajudeen
- Department of Otorhinolaryngology-Head and Neck Surgery, Rush Center for Skull Base and Pituitary Surgery, Rush University Medical Center, Chicago, Illinois, U.S.A
| |
Collapse
|
37
|
Radiotherapy for Melanoma: More than DNA Damage. Dermatol Res Pract 2019; 2019:9435389. [PMID: 31073304 PMCID: PMC6470446 DOI: 10.1155/2019/9435389] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2018] [Revised: 11/26/2018] [Accepted: 03/04/2019] [Indexed: 12/20/2022] Open
Abstract
Despite its reputation as a radioresistant tumour, there is evidence to support a role for radiotherapy in patients with melanoma and we summarise current clinical practice. Melanoma is a highly immunogenic tumour and in this era of immunotherapy, there is renewed interest in the potential of irradiation, not only as an adjuvant and palliative treatment, but also as an immune stimulant. It has long been known that radiation causes not only DNA strand breaks, apoptosis, and necrosis, but also immunogenic modulation and cell death through the induction of dendritic cells, cell adhesion molecules, death receptors, and tumour-associated antigens, effectively transforming the tumour into an individualised vaccine. This immune response can be enhanced by the application of clinical hyperthermia as evidenced by randomised trial data in patients with melanoma. The large fraction sizes used in cranial radiosurgery and stereotactic body radiotherapy are more immunogenic than conventional fractionation, which provides additional radiobiological justification for these techniques in this disease entity. Given the immune priming effect of radiotherapy, there is a strong but complex biological rationale and an increasing body of evidence for synergy in combination with immune checkpoint inhibitors, which are now first-line therapy in patients with recurrent or metastatic melanoma. There is great potential to increase local control and abscopal effects by combining radiotherapy with both immunotherapy and hyperthermia, and a combination of all three modalities is suggested as the next important trial in this refractory disease.
Collapse
|
38
|
Abstract
PURPOSE OF REVIEW Sinonasal mucosal melanoma (SNMM) is an aggressive cancer with a poor prognosis. Although there is significant study surrounding the treatment of sinonasal malignancies and cutaneous melanomas, the rarity of this tumor has largely precluded robust outcomes analyses. The authors of this review seek to provide an overview of the recent literature related to the treatment of SNMM with added context from our institutional experience with this disease. RECENT FINDINGS In the surgical management of sinonasal malignancies and SNMM specifically, resection via endoscopic endonasal technique appears to offer comparable oncologic outcomes versus an open approach. The role of adjuvant therapy continues to be debated, but there is strong evidence for improved rates of local control with radiotherapy after complete resection. In the last few years, significant developments have been made in the study of systemic therapies for cutaneous melanoma. The identification of genetic mutations common to mucosal melanoma has allowed for early trials of targeted therapies, but study is ongoing. SUMMARY Although the study of SNMM is largely limited to small retrospective case series, treatment continues to evolve. Until effective systemic therapies can be identified, endoscopic resection with adjuvant radiotherapy may offer the best disease-free survival with acceptably low morbidity.
Collapse
|
39
|
Amit M, Tam S, Abdelmeguid AS, Kupferman ME, Su SY, Raza SM, DeMonte F, Hanna EY. Patterns of Treatment Failure in Patients with Sinonasal Mucosal Melanoma. Ann Surg Oncol 2018; 25:1723-1729. [PMID: 29626308 DOI: 10.1245/s10434-018-6465-y] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2017] [Indexed: 02/06/2023]
Abstract
BACKGROUND Head and neck mucosal melanoma is a locally aggressive tumor with a high recurrence rate. The paranasal sinuses and nasal cavity are the most common primary tumor sites. OBJECTIVE The purpose of this retrospective study was to identify independent predictors of outcome in sinonasal mucosal melanoma (SNMM) and characterize the patterns of treatment failure. METHODS This study included 198 patients with SNMM who had been treated at The University of Texas MD Anderson Cancer Center from 1 January 1991 through 31 December 2016. The survival outcomes included overall survival (OS), disease-specific survival (DSS), disease-free survival (DFS), local recurrence-free survival, and distant metastasis-free survival. A stepwise regression analysis was used to assess associations in the multivariate models. RESULTS The 5-year OS, DSS, and DFS rates were 38, 58, and 27%, respectively. Independent predictors of poor OS and DSS were the paranasal sinuses as the primary tumor site [hazard ratio (HR) 1.73, 95% confidence interval (CI) 1.11-2.66; and HR 2.12, 95% CI 1.21-3.74, respectively] and the presence of distant metastases at presentation (HR 4.53, 95% CI 2.24-7.83; and HR 3.6, 95% CI 1.12-7.1). Recurrence occurred in 96 patients (48%). The most common cause of treatment failure was distant metastasis in 69 of 198 patients (35%), followed by local [36 (18%)] and regional [22 (11%)] recurrence. CONCLUSION The most common cause of treatment failure in SNMM is distant metastasis. The tumor site and the presence of metastatic disease at presentation were the only independent predictors of survival. These data can be used to inform quality improvement efforts and the counseling of high-risk SNMM patients.
Collapse
Affiliation(s)
- Moran Amit
- Department of Head and Neck Surgery, Division of Surgery, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Samantha Tam
- Department of Head and Neck Surgery, Division of Surgery, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Ahmed S Abdelmeguid
- Department of Head and Neck Surgery, Division of Surgery, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Michael E Kupferman
- Department of Head and Neck Surgery, Division of Surgery, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Shirley Y Su
- Department of Head and Neck Surgery, Division of Surgery, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Shaan M Raza
- Department of Neurosurgery, Division of Surgery, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Franco DeMonte
- Department of Neurosurgery, Division of Surgery, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Ehab Y Hanna
- Department of Head and Neck Surgery, Division of Surgery, The University of Texas MD Anderson Cancer Center, Houston, TX, USA. .,Department of Head and Neck Surgery, Division of Surgery, Unit 1445, The University of Texas MD Anderson Cancer Center, Houston, TX, USA.
| |
Collapse
|
40
|
Śniegocka M, Podgórska E, Płonka PM, Elas M, Romanowska-Dixon B, Szczygieł M, Żmijewski MA, Cichorek M, Markiewicz A, Brożyna AA, Słominski AT, Urbańska K. Transplantable Melanomas in Hamsters and Gerbils as Models for Human Melanoma. Sensitization in Melanoma Radiotherapy-From Animal Models to Clinical Trials. Int J Mol Sci 2018; 19:E1048. [PMID: 29614755 PMCID: PMC5979283 DOI: 10.3390/ijms19041048] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2017] [Revised: 03/27/2018] [Accepted: 03/28/2018] [Indexed: 12/18/2022] Open
Abstract
The focus of the present review is to investigate the role of melanin in the radioprotection of melanoma and attempts to sensitize tumors to radiation by inhibiting melanogenesis. Early studies showed radical scavenging, oxygen consumption and adsorption as mechanisms of melanin radioprotection. Experimental models of melanoma in hamsters and in gerbils are described as well as their use in biochemical and radiobiological studies, including a spontaneously metastasizing ocular model. Some results from in vitro studies on the inhibition of melanogenesis are presented as well as radio-chelation therapy in experimental and clinical settings. In contrast to cutaneous melanoma, uveal melanoma is very successfully treated with radiation, both using photon and proton beams. We point out that the presence or lack of melanin pigmentation should be considered, when choosing therapeutic options, and that both the experimental and clinical data suggest that melanin could be a target for radiosensitizing melanoma cells to increase efficacy of radiotherapy against melanoma.
Collapse
Affiliation(s)
- Martyna Śniegocka
- Department of Biophysics, Faculty of Biochemistry, Biophysics and Biotechnology, Jagiellonian University in Kraków, 31-007 Kraków, Poland.
| | - Ewa Podgórska
- Department of Biophysics, Faculty of Biochemistry, Biophysics and Biotechnology, Jagiellonian University in Kraków, 31-007 Kraków, Poland.
| | - Przemysław M Płonka
- Department of Biophysics, Faculty of Biochemistry, Biophysics and Biotechnology, Jagiellonian University in Kraków, 31-007 Kraków, Poland.
| | - Martyna Elas
- Department of Biophysics, Faculty of Biochemistry, Biophysics and Biotechnology, Jagiellonian University in Kraków, 31-007 Kraków, Poland.
| | - Bożena Romanowska-Dixon
- Department of Ophthalmology and Ocular Oncology, Medical College of Jagiellonian University in Kraków, 31-007 Kraków, Poland.
| | - Małgorzata Szczygieł
- Department of Biophysics, Faculty of Biochemistry, Biophysics and Biotechnology, Jagiellonian University in Kraków, 31-007 Kraków, Poland.
| | - Michał A Żmijewski
- Department of Histology, Medical University of Gdansk, 80-210 Gdańsk, Poland.
| | - Mirosława Cichorek
- Department of Embryology, Medical University of Gdansk, 80-210 Gdańsk, Poland.
| | - Anna Markiewicz
- Department of Ophthalmology and Ocular Oncology, Medical College of Jagiellonian University in Kraków, 31-007 Kraków, Poland.
| | - Anna A Brożyna
- Department of Tumor Pathology and Pathomorphology, Faculty of Health Sciences, Nicolaus Copernicus University Collegium Medicum in Bydgoszcz, Oncology Centre-Prof. Franciszek Łukaszczyk Memorial Hospital, 85-796 Bydgoszcz, Poland.
- Department of Dermatology, Comprehensive Cancer Center Cancer Chemoprevention Program, University of Alabama at Birmingham, Birmingham, AL 35294, USA.
| | - Andrzej T Słominski
- Department of Dermatology, Comprehensive Cancer Center Cancer Chemoprevention Program, University of Alabama at Birmingham, Birmingham, AL 35294, USA.
- VA Medical Center, Birmingham, AL 35294, USA.
| | - Krystyna Urbańska
- Department of Biophysics, Faculty of Biochemistry, Biophysics and Biotechnology, Jagiellonian University in Kraków, 31-007 Kraków, Poland.
| |
Collapse
|
41
|
Abstract
Sinonasal mucosal melanoma (SNMM) is a rare oncological entity that comprises most head and neck mucosal melanomas. SNMM has distinctive genetic background, different from cutaneous melanoma. Survival outcomes among SNMM patients are poor; while there is no clear consensus on the optimal management of SNMM, the primary treatment modality is generally considered to be wide surgical excision, and radiation therapy (RT) is often used in the postoperative adjuvant setting to improve locoregional control. Systemic therapies have demonstrated little or no survival benefit, and most SNMM patients die of distant metastatic disease. Owing to the rarity of the disease, the literature describing treatment approaches for SNMM is lacking and largely limited to isolated case reports and retrospective series. Here, we describe contemporary diagnostic and therapeutic approaches to SNMM based on the most recent molecular and outcome data.
Collapse
|
42
|
Caspers CJI, Dronkers EAC, Monserez D, Wieringa MH, Baatenburg de Jong RJ, Hardillo JAU. Adjuvant radiotherapy in sinonasal mucosal melanoma: A retrospective analysis. Clin Otolaryngol 2017; 43:617-623. [PMID: 29150980 DOI: 10.1111/coa.13033] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/11/2017] [Indexed: 01/09/2023]
Abstract
OBJECTIVES Evaluation of outcome after curative treatment for sinonasal mucosal melanoma focused on the effect of adjuvant radiotherapy on recurrence and survival. DESIGN Retrospective chart analysis. SETTING Tertiary referral hospital. PARTICIPANTS Fifty-one patients with primary sinonasal mucosal melanoma who underwent surgical resection with curative intention between 1980 and 2016 at Erasmus Medical Center, Rotterdam. MAIN OUTCOME MEASURES Patients were categorised into 2 groups: surgery alone and surgery with adjuvant radiotherapy. Log-rank test was used to compare rates of recurrence and survival between treatment groups. Predictors for treatment modality, recurrence and survival were assessed with multivariate statistical analysis. RESULTS Of all patients, 23.5% developed local recurrence and 47.1% developed distant metastasis. Estimated 5-year disease-free survival was 25.2%, and 5-year overall survival (OS) was 38.1%. Forty-three patients (84.3%) were treated with post-operative radiotherapy. Patients who underwent surgery with adjuvant radiotherapy presented more often with high tumour stage, tumour involving multiple sites and positive margins. Post-operative radiotherapy seemed to be associated with better local control (P = .549). No effect was found on occurrence of distant metastasis and OS. Positive margin status was an independent negative predictor for distant metastasis-free survival and overall survival. CONCLUSIONS Our treatment outcomes are consistent with literature. Post-operative radiotherapy seems to be associated with improved local control despite advanced disease and positive margin status in this treatment group.
Collapse
Affiliation(s)
- C J I Caspers
- Department of Otorhinolaryngology and Head and Neck Surgery, Erasmus University Medical Center (EMC), Rotterdam, The Netherlands
| | - E A C Dronkers
- Department of Otorhinolaryngology and Head and Neck Surgery, Erasmus University Medical Center (EMC), Rotterdam, The Netherlands
| | - D Monserez
- Department of Otorhinolaryngology and Head and Neck Surgery, Erasmus University Medical Center (EMC), Rotterdam, The Netherlands
| | - M H Wieringa
- Department of Otorhinolaryngology and Head and Neck Surgery, Erasmus University Medical Center (EMC), Rotterdam, The Netherlands
| | - R J Baatenburg de Jong
- Department of Otorhinolaryngology and Head and Neck Surgery, Erasmus University Medical Center (EMC), Rotterdam, The Netherlands
| | - J A U Hardillo
- Department of Otorhinolaryngology and Head and Neck Surgery, Erasmus University Medical Center (EMC), Rotterdam, The Netherlands
| |
Collapse
|
43
|
Amit M, Tam S, Abdelmeguid AS, Kupferman ME, Su SY, Raza SM, DeMonte F, Hanna EY. Role of Adjuvant Treatment in Sinonasal Mucosal Melanoma. J Neurol Surg B Skull Base 2017; 78:512-518. [PMID: 29142805 PMCID: PMC5683413 DOI: 10.1055/s-0037-1604350] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2017] [Accepted: 06/10/2017] [Indexed: 02/03/2023] Open
Abstract
Purpose Sinonasal mucosal melanoma (SNMM) is a locally aggressive tumor. This study aimed to define the role of adjuvant treatment and its association with survival outcomes of SNMM. Methods This retrospective study investigated 152 patients with SNMM treated between 1991 and 2016 in MD Anderson Cancer Center. Patients were divided into the following treatment groups: surgery alone, surgery with postoperative radiotherapy (PORT), surgery with postoperative chemoradiation (POCRT), and induction chemotherapy followed by surgery and PORT. Overall survival (OS), disease-specific survival, and relapse-free survival were compared. Survival between the groups was compared using univariate and multivariate analyses. Results The median follow-up was 28 months (range: 2-220 months). Five-year OS rates were 39, 42, 47, and 27% for the surgery only, PORT, POCRT, and neoadjuvant chemotherapy groups, respectively (log rank p = 0.73). Distant metastasis was the most common form of treatment failure and occurred in 59 (39%) patients. Five-year distant metastasis rates were 51, 45, and 58% for patients treated with surgery alone, PORT, and POCRT, respectively (log rank p = 0.21) but unable to be estimated in the neoadjuvant chemotherapy group due to low OS rates. Multivariate analysis demonstrated tumor site (hazard ratio [HR] = 2.32, 95% confidence interval [CI] = 1.24-4.15) and smoking status (HR = 1.77, 95% CI = 1.02-3.1) to be significant prognostic factors for survival. Conclusion Tumor site and smoking status were significant prognosticators in SNMM. A high rate of distant metastatic disease suggests that further investigation into novel, systemic therapies is required to improve outcomes in this disease entity.
Collapse
Affiliation(s)
- Moran Amit
- Department of Head and Neck Surgery, Division of Surgery, The University of
Texas MD Anderson Cancer Center, Houston, Texas, United States
| | - Samantha Tam
- Department of Head and Neck Surgery, Division of Surgery, The University of
Texas MD Anderson Cancer Center, Houston, Texas, United States
| | - Ahmed S. Abdelmeguid
- Department of Head and Neck Surgery, Division of Surgery, The University of
Texas MD Anderson Cancer Center, Houston, Texas, United States
- Department of Otolaryngology Head and Neck Surgery, Faculty of Medicine,
Mansoura University, Egypt
| | - Michael E. Kupferman
- Department of Head and Neck Surgery, Division of Surgery, The University of
Texas MD Anderson Cancer Center, Houston, Texas, United States
| | - Shirley Y. Su
- Department of Head and Neck Surgery, Division of Surgery, The University of
Texas MD Anderson Cancer Center, Houston, Texas, United States
| | - Shaan M. Raza
- Department of Neurosurgery, Division of Surgery, The University of Texas MD
Anderson Cancer Center, Houston, Texas, United States
| | - Franco DeMonte
- Department of Neurosurgery, Division of Surgery, The University of Texas MD
Anderson Cancer Center, Houston, Texas, United States
| | - Ehab Y. Hanna
- Department of Head and Neck Surgery, Division of Surgery, The University of
Texas MD Anderson Cancer Center, Houston, Texas, United States
| |
Collapse
|
44
|
Lansu J, Klop WM, Heemsbergen W, Navran A, Al-Mamgani A, Langendijk JA, Kaanders JH, Terhaard C, Karakullukcu B, Hamming-Vrieze O. Local control in sinonasal malignant melanoma: Comparing conventional to hypofractionated radiotherapy. Head Neck 2017; 40:86-93. [PMID: 29044881 DOI: 10.1002/hed.24979] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2017] [Revised: 07/29/2017] [Accepted: 09/03/2017] [Indexed: 02/03/2023] Open
Abstract
BACKGROUND The purpose of this study was to analyze the effect of fractionation schedule on local control in postoperative radiotherapy (RT) for sinonasal malignant melanoma. METHODS Sixty-three patients who were treated with surgery and postoperative RT in 4 accredited head and neck cancer centers in the Netherlands between 1998 and 2013 were retrospectively studied. Outcomes with conventional fractionation (2-2.4 Gy per fraction; n = 27) were compared to hypofractionation (4-6 Gy per fraction; n = 36). The primary endpoint was local control and the secondary endpoint was toxicity. RESULTS Comparable local control rates were found after 2 and 5 years (63% vs 64% and 47% vs 53%; P = .73 for, respectively, conventional fractionation vs hypofractionation). Local recurrences were predominantly present ipsilateral (92%) and within the irradiated volume (88%). Late toxicity grade ≥ 3 was observed in 2 of 63 patients, 1 patient in both groups. CONCLUSION Radiotherapy fractionation schedule did not influence the local control rate or the incidence of late toxicity in patients treated with surgery and RT for sinonasal malignant melanoma in this retrospective analysis. Due to this retrospective nature and the limited number of patients, strong recommendations cannot be made. Expected toxicity, patient convenience, and workload may be taken into account for the choice of fractionation schedule until conclusive evidence becomes available.
Collapse
Affiliation(s)
- Jules Lansu
- Department of Radiation Oncology, Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Willem Martin Klop
- Department of Head and Neck Surgery and Oncology, Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Wilma Heemsbergen
- Department of Radiation Oncology, Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Arash Navran
- Department of Radiation Oncology, Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Abrahim Al-Mamgani
- Department of Radiation Oncology, Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Johannes A Langendijk
- Department of Radiation Oncology, University Medical Center Groningen, Groningen, The Netherlands
| | - Johannes H Kaanders
- Department of Radiation Oncology, Radboud University Medical Centre, Nijmegen, The Netherlands
| | - Chris Terhaard
- Department of Radiotherapy, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Baris Karakullukcu
- Department of Head and Neck Surgery and Oncology, Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Olga Hamming-Vrieze
- Department of Radiation Oncology, Netherlands Cancer Institute, Amsterdam, The Netherlands
| |
Collapse
|
45
|
Sun S, Huang X, Gao L, Zhang Y, Luo J, Zhang S, Wang K, Qu Y, Wu R, Liu Q, Xiao J, Xu G, Yi J. Long-term treatment outcomes and prognosis of mucosal melanoma of the head and neck: 161 cases from a single institution. Oral Oncol 2017; 74:115-122. [PMID: 29103739 DOI: 10.1016/j.oraloncology.2017.09.020] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2017] [Revised: 07/27/2017] [Accepted: 09/26/2017] [Indexed: 02/03/2023]
Abstract
OBJECTIVES This study aimed to evaluate the clinical features, treatment outcomes and prognostic factors of mucosal melanoma of the head and neck (MMHN) in patients who were treated at our institution. MATERIALS AND METHODS Between Jan. 1981 and Oct. 2015, 161 patients with non-metastatic MMHN were treated at our institution. The patients' clinical characteristics, treatment modalities, outcomes, prognostic factors, and failure patterns were retrospectively analysed. RESULTS With a median follow-up time of 74months, the 5-year overall survival rate (OS), local control rate (LC), distant metastasis-free survival (DMFS) were 44.4%, 59.4%, and 49.3%, respectively. Regarding the different treatment modalities, the 5-year OS was 50.0% in the surgery group and 43.1% in the surgery combined with radiotherapy group, while, the 5-year LC rate was 42.5% in the surgery group and 75.3% in the surgery combined with radiotherapy (p<0.001). According to the AJCC 7th edition staging system for MMHN, the 5-year OS for patients with stage III, stage IVA, and stage IVB MMHN were 65.2%, 33.1% and 14.3%, respectively (p<0.001). In the multivariate analysis, the T stage, neck lymph node involvement, and surgical margins were independent prognostic factors for OS; surgical margins and adjuvant radiotherapy were independent prognostic factors for LC. CONCLUSION The addition of radiotherapy improves the local control rate of MMHN. T stage, neck lymph node status, and surgical margins are independent prognostic factors for the OS in patients with MMHN. The AJCC 7th edition staging system for MMHN appears to effectively stage this disease.
Collapse
Affiliation(s)
- Shiran Sun
- National Cancer Center/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, China.
| | - Xiaodong Huang
- National Cancer Center/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, China.
| | - Li Gao
- National Cancer Center/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, China.
| | - Ye Zhang
- National Cancer Center/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, China.
| | - Jingwei Luo
- National Cancer Center/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, China.
| | - Shiping Zhang
- National Cancer Center/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, China.
| | - Kai Wang
- National Cancer Center/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, China.
| | - Yuan Qu
- National Cancer Center/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, China.
| | - Runye Wu
- National Cancer Center/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, China.
| | - Qingfeng Liu
- National Cancer Center/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, China.
| | - Jianping Xiao
- National Cancer Center/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, China.
| | - Guozhen Xu
- National Cancer Center/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, China.
| | - Junlin Yi
- National Cancer Center/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, China.
| |
Collapse
|
46
|
Dréno M, Georges M, Espitalier F, Ferron C, Charnolé A, Dréno B, Malard O. Sinonasal mucosal melanoma: A 44-case study and literature analysis. Eur Ann Otorhinolaryngol Head Neck Dis 2017; 134:237-242. [PMID: 28442409 DOI: 10.1016/j.anorl.2017.02.003] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
OBJECTIVES Sinonasal mucosal melanoma is a rare disease, representing 4% of nasal cavity and paranasal sinus malignancies. The aim of this study was to assess the clinical characteristics, progression and treatment of this disease and to identify prognostic factors. MATERIAL AND METHODS This retrospective review presents a cohort of 44 patients treated for a melanoma arising from the nasal cavity and paranasal sinuses, in the ENT Head and Neck Surgery Department of the University Hospital of Nantes (France) between 1988 and 2015. RESULTS Mean age at diagnosis was 71.2 years. The main signs at diagnosis were epistaxis and unilateral nasal obstruction. 25% of patients were initially classified as T4. Surgical treatment was performed in 42 patients. Postoperative radiotherapy was performed in 19 cases and adjuvant immunotherapy in 14 cases. Mean follow-up was 50 months. Cumulative overall survival was 71.5% at 1 year and 33% at 5 years. Clinically, headache, facial pain and trigeminal V2 nerve anesthesia were significant factors for poor prognosis. Exclusively nasal involvement was a factor for better overall survival than sinus involvement. Adjuvant radiation therapy showed a non-significant trend toward improved local control. CONCLUSIONS Mucosal melanoma of the sinonasal cavities has poor prognosis due to high metastatic potential. Surgical resection followed by radiation therapy is the main treatment. There is no consensus regarding new systemic adjuvant treatments in this indication, unlike for primary cutaneous melanoma.
Collapse
Affiliation(s)
- M Dréno
- Service d'ORL et de Chirurgie Cervico-Faciale, Centre Hospitalier Universitaire, 1 Place Alexis-Ricordeau, 44093 Nantes Cedex 1, France
| | - M Georges
- Service d'Anatomopathologie, Centre Hospitalier Universitaire, 1 Place Alexis-Ricordeau, 44093 Nantes Cedex 1, France
| | - F Espitalier
- Service d'ORL et de Chirurgie Cervico-Faciale, Centre Hospitalier Universitaire, 1 Place Alexis-Ricordeau, 44093 Nantes Cedex 1, France
| | - C Ferron
- Service d'ORL et de Chirurgie Cervico-Faciale, Centre Hospitalier Universitaire, 1 Place Alexis-Ricordeau, 44093 Nantes Cedex 1, France
| | - A Charnolé
- Service d'ORL et de Chirurgie Cervico-Faciale, Centre Hospitalier Universitaire, 1 Place Alexis-Ricordeau, 44093 Nantes Cedex 1, France
| | - B Dréno
- Service de Dermatologie, Centre Hospitalier Universitaire, 1 Place Alexis-Ricordeau, 44093 Nantes Cedex 1, France
| | - O Malard
- Service d'ORL et de Chirurgie Cervico-Faciale, Centre Hospitalier Universitaire, 1 Place Alexis-Ricordeau, 44093 Nantes Cedex 1, France.
| |
Collapse
|
47
|
Green B, Elhamshary A, Gomez R, Rahimi S, Brennan PA. An update on the current management of head and neck mucosal melanoma. J Oral Pathol Med 2017; 46:475-479. [DOI: 10.1111/jop.12526] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/16/2016] [Indexed: 02/03/2023]
Affiliation(s)
- Ben Green
- Department of Gastroenterology; Torbay Hospital; Torquay UK
| | - Ahmed Elhamshary
- Department of Oral & Maxillofacial Surgery; Queen Alexandra Hospital; Portsmouth UK
| | - Ricardo Gomez
- Department of Oral Surgery & Pathology; School of Dentistry; Universidade Federal de Minas Gerais-UFMG; Belo-Horizonte Brazil
| | - Siavash Rahimi
- Department of Histopathology; Queen Alexandra Hospital; Portsmouth UK
| | - Peter A. Brennan
- Department of Oral & Maxillofacial Surgery; Queen Alexandra Hospital; Portsmouth UK
| |
Collapse
|
48
|
Jarrom D, Paleri V, Kerawala C, Roques T, Bhide S, Newman L, Winter SC. Mucosal melanoma of the upper airways tract mucosal melanoma: A systematic review with meta-analyses of treatment. Head Neck 2016; 39:819-825. [PMID: 27898196 DOI: 10.1002/hed.24652] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2016] [Revised: 08/31/2016] [Accepted: 10/21/2016] [Indexed: 01/20/2023] Open
Abstract
BACKGROUND Mucosal melanoma of the upper aerodigestive tract (MM-UADT) occurs in a complex anatomic region. It represents a small number of tumors of the head and neck and a small number of melanoma cases. METHODS Search strategies initially identified 600, 11 of which were included in this study. RESULTS All studies involved surgery and radiotherapy. None were randomized, and all were assessed as having a high risk of selection and performance bias. No studies reported quality of life, treatment-related mortality, or morbidity. The results indicate that the addition of radiotherapy to surgery reduces the rate of locoregional recurrence (hazard ratio [HR], 0.60; 95% confidence interval [CI], 0.42-0.87). There was no statistically significant difference in overall survival (HR, 1.16; 95% CI, 0.98-1.37). CONCLUSION Surgical resection with postoperative radiotherapy remains the optimal treatment strategy for locoregional control. More robust studies and the use of molecular targeted therapies need to be undertaken to improve overall survival. © 2016 Wiley Periodicals, Inc. Head Neck 39: 819-825, 2017.
Collapse
Affiliation(s)
- David Jarrom
- National Collaborating Centre for Cancer, Park House, Cardiff, United Kingdom
| | - Vinidh Paleri
- Department of Otolaryngology - Head and Neck Surgery, Newcastle upon Tyne Hospitals NHS Trust, Newcastle upon Tyne, United Kingdom.,Department of Head and Neck Surgery, Northern Institute for Cancer Research, Newcastle University, Newcastle upon Tyne, United Kingdom
| | - Cyrus Kerawala
- Department of Maxillofacial / Head and Neck Surgery, The Royal Marsden Hospital, Greater London, United Kingdom
| | - Thomas Roques
- Department of Clinical Oncology, Norfolk and Norwich University Hospitals NHS Foundation Trust, Norwich, United Kingdom
| | - Shreerang Bhide
- Department of Clinical Oncology, The Royal Marsden Hospital NHS Foundation Trust, Sutton, Surrey, United Kingdom
| | - Laurence Newman
- Department of Maxillofacial / Head and Neck Surgery, The Queen Victoria Hospital NHS Foundation Trust, East Grinstead, West Sussex, United Kingdom
| | - Stuart C Winter
- Department of ENT Surgery, Oxford University NHS Trusts, Oxford, United Kingdom
| |
Collapse
|
49
|
Li YJ, Dai YL, Cheng YS, Zhang WB, Tu CQ. Positron emission tomography (18)F-fluorodeoxyglucose uptake and prognosis in patients with bone and soft tissue sarcoma: A meta-analysis. EUROPEAN JOURNAL OF SURGICAL ONCOLOGY 2016; 42:1103-14. [PMID: 27189833 DOI: 10.1016/j.ejso.2016.04.056] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2016] [Revised: 04/04/2016] [Accepted: 04/08/2016] [Indexed: 02/05/2023]
Abstract
PURPOSE To investigate the prognostic significance of (18)F-FDG PET imaging in patients with bone and soft tissue sarcoma, a meta-analysis was conducted. METHODS Comprehensive literature searches were performed in PubMed, Embase, Web of Science and Cochrane Library. Pooled hazard ratio (HR) values were calculated to assess the correlations of pre-chemotherapy SUV (SUV1), post-chemotherapy SUV (SUV2), SUV Ratio, total lesion glycolysis (TLG) and metabolic tumor volume (MTV) with event-free survival (EFS) and overall survival (OS). RESULTS Twenty-three studies with 1261 patients were identified. The combined HRs for EFS were 1.84 (95% CI: 1.54-2.20) for SUV1, 2.92 (95% CI: 2.15-3.97) for SUV2, 1.90 (95% CI: 1.43-2.52) for SUV Ratio, 3.01 (95% CI: 1.36-6.67) for TLG and 2.32 (95% CI: 1.44-3.75) for MTV. The pooled HRs for OS were 1.85 (95% CI: 1.49-2.30) for SUV1, 2.00 (95% CI: 1.39-2.88) for SUV2, 2.20 (95% CI: 1.18-4.10) for SUV Ratio, 6.19 (95% CI: 2.17-17.66) for TLG and 2.67 (95% CI: 1.52-4.68) for MTV. Besides, high SUV1 was found to be significantly associated with higher rate of metastasis (RR 5.55, 95% CI: 2.75-11.18) and local recurrence (RR 1.87 95% CI: 1.28-2.72). CONCLUSION (18)F-FDG PET parameters of SUV1, SUV2, SUV Ratio, TLG and MTV may have effective prognostic significance for patients with bone and soft tissue sarcoma. (18)F-FDG PET imaging may be a promising tool to help predict survival outcomes of these patients.
Collapse
Affiliation(s)
- Y-J Li
- Department of Orthopedics, West China Hospital, Sichuan University, Chengdu, PR China; Department of Cancer Center, West China Hospital, Sichuan University, Chengdu, PR China.
| | - Y-L Dai
- College of Computer Science, Sichuan Normal University, Chengdu, PR China
| | - Y-S Cheng
- Department of Orthopedics, West China Hospital, Sichuan University, Chengdu, PR China
| | - W-B Zhang
- Department of Orthopedics, West China Hospital, Sichuan University, Chengdu, PR China
| | - C-Q Tu
- Department of Orthopedics, West China Hospital, Sichuan University, Chengdu, PR China.
| |
Collapse
|
50
|
Yang B, Li Q, Zhao H, Liu H, Tang T, Jiang C. Local anesthetic thoracoscopy for the diagnosis of metastatic pleural melanoma originated from oral malignant melanoma: case report and comments. World J Surg Oncol 2015; 13:326. [PMID: 26628037 PMCID: PMC4666196 DOI: 10.1186/s12957-015-0741-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2015] [Accepted: 11/23/2015] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Oral malignant melanoma (OMM) is an aggressive tumor with very low survival rate and easy to metastasize. Pleural metastatic melanoma via primary OMM is rare. CASE PRESENTATION In this report, we presented a case of metastatic malignant melanoma of the pleura originated from OMM. A 54-year-old man without primary skin lesion was diagnosed multiple nodular shadows, pleural invasion, and pleural effusion by chest computed tomography (CT). One cyst-form tumor on the tongue base was observed by bronchoscopy, which was diagnosed as OMM by pathological examination and then was resected. After getting the tumor tissues from the pleura by pleural biopsy surgery, the diagnosis of pathological examination was pleural metastatic melanoma. Furthermore, tumor cells displayed a positive immunoreaction for melanocytic markers S100 and HMB-45 combining with positive vimentin and cytokeratin AE1/AE3. The patient was therefore diagnosed with metastatic melanoma of the left pleura and the primary melanoma was OMM. CONCLUSIONS According to this case, we could draw the conclusion that pleural metastasis from OMM was very rare and thoracoscopy preceded under local anesthesia is an important method for its accurate diagnosis.
Collapse
Affiliation(s)
- Bingjun Yang
- Department of Thoracic Surgery, Tianjin Union Medicine Centre, 190 Jieyuan Road, Hongqiao District, Tianjin, 300121, People's Republic of China.
| | - Qingzhao Li
- School of Public Health, North China University of Science and Technology, Tangshan, 063001, Hebei, People's Republic of China.
| | - Hui Zhao
- Department of Thoracic Surgery, Tianjin Union Medicine Centre, 190 Jieyuan Road, Hongqiao District, Tianjin, 300121, People's Republic of China.
| | - Huibin Liu
- Office of Clinical Drug Trial Institution, The Affiliated Tumor Hospital of Xinjiang Medical University, Urumqi, Xinjiang, 830011, People's Republic of China.
| | - Tao Tang
- Department of Pathology, Tianjin Union Medicine Centre, 190 Jieyuan Road, Hongqiao District, Tianjin, 300121, People's Republic of China.
| | - Chunyang Jiang
- Department of Thoracic Surgery, Tianjin Union Medicine Centre, 190 Jieyuan Road, Hongqiao District, Tianjin, 300121, People's Republic of China.
| |
Collapse
|