Contemporary outcomes from the use of regular imaging to detect relapse in high-risk cutaneous melanoma

Kok Haw Jonathan Lim; Lavinia Spain; Claire Barker; Alexandros Georgiou; Gerard Walls; Martin Gore; Samra Turajlic; Ruth Board; James M Larkin; Paul Lorigan

doi:10.1136/esmoopen-2017-000317

Contemporary outcomes from the use of regular imaging to detect relapse in high-risk cutaneous melanoma

Kok Haw Jonathan Lim, Lavinia Spain, Claire Barker, Alexandros Georgiou, Gerard Walls, Martin Gore, Samra Turajlic, Ruth Board, James M Larkin, Paul Lorigan

School of Medicine, Dentistry and Biomedical Sciences

Research output: Contribution to journal › Article › peer-review

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Abstract

Background Agreement on the utility of imaging followup in patients with high-risk melanoma is lacking. A UK consensus statement recommends a surveillance schedule of CT or positron-emission tomography-CT and MRI brain (every 6months for 3years, then annually in years 4 and 5) as well as clinical examination for high-risk resected Stages II and III cutaneous melanoma. Our aim was to assess patterns of relapse and whether imaging surveillance could be of clinical benefit. Patients and methods A retrospective study of patients enrolled between July 2013 and June 2015 from three UK tertiary cancer centres followed-up according to this protocol was undertaken. We evaluated time-to-recurrence (TTR), recurrence-free survival (RFS), method of detection and characteristics of recurrence, treatment received and overall survival (OS). Results A total of 173 patients were included. Most (79%) had treated Stages IIIB and IIIC disease. With a median follow-up of 23.3months, 82 patients (47%) had relapsed. Median TTR was 10.1months and median RFS was 21.2months. The majority of recurrences (66%) were asymptomatic and detected by scheduled surveillance scan. Fifty-six (68%) patients recurred with Stage IV disease, with a median OS of 25.3months; 26 (31.7%) patients had a locoregional recurrence, median OS not reached (P=0.016). Patients who underwent surgery at recurrence for either Stage III (27%) or IV (18%) disease did not reach their median OS. The median OS for the 33 patients (40%) who received systemic therapy was 12.9months. Conclusion Imaging appears to reliably detect subclinical disease and identify patients suitable for surgery, conferring favourable outcomes. The short median TTR provides rationale to intensify imaging schedule in the first year of surveillance. The poor OS of patients treated with systemic therapy probably reflects the relatively inferior treatment options during this time and requires further evaluation in the current era.

Original language	English
Article number	e000317
Number of pages	6
Journal	ESMO Open
Volume	3
DOIs	https://doi.org/10.1136/esmoopen-2017-000317
Publication status	Published - 24 Feb 2018

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10.1136/esmoopen-2017-000317Licence: CC BY-NC

Contemporary outcomes from the use of regular imaging to detect relapse in high-risk cutaneous melanoma
© 2018 European Society for Medical Oncology (unless otherwise stated in the text of the article). All rights reserved. This is an Open Access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/ licenses/by-nc/4.0
Final published version, 245 KBLicence: CC BY-NC

Biophysical correlates of base-mediated radiation cardiotoxicity in non-small cell lung cancer
Walls, G. M. (Author), Butterworth, K. (Supervisor), Jain, S. (Supervisor) & Cole, A. (Supervisor), Jul 2023
Student thesis: Doctoral Thesis › Doctor of Philosophy

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@article{9b0b998c62774c7e9a6607a0a31dcfdd,

title = "Contemporary outcomes from the use of regular imaging to detect relapse in high-risk cutaneous melanoma",

abstract = "Background Agreement on the utility of imaging followup in patients with high-risk melanoma is lacking. A UK consensus statement recommends a surveillance schedule of CT or positron-emission tomography-CT and MRI brain (every 6months for 3years, then annually in years 4 and 5) as well as clinical examination for high-risk resected Stages II and III cutaneous melanoma. Our aim was to assess patterns of relapse and whether imaging surveillance could be of clinical benefit. Patients and methods A retrospective study of patients enrolled between July 2013 and June 2015 from three UK tertiary cancer centres followed-up according to this protocol was undertaken. We evaluated time-to-recurrence (TTR), recurrence-free survival (RFS), method of detection and characteristics of recurrence, treatment received and overall survival (OS). Results A total of 173 patients were included. Most (79%) had treated Stages IIIB and IIIC disease. With a median follow-up of 23.3months, 82 patients (47%) had relapsed. Median TTR was 10.1months and median RFS was 21.2months. The majority of recurrences (66%) were asymptomatic and detected by scheduled surveillance scan. Fifty-six (68%) patients recurred with Stage IV disease, with a median OS of 25.3months; 26 (31.7%) patients had a locoregional recurrence, median OS not reached (P=0.016). Patients who underwent surgery at recurrence for either Stage III (27%) or IV (18%) disease did not reach their median OS. The median OS for the 33 patients (40%) who received systemic therapy was 12.9months. Conclusion Imaging appears to reliably detect subclinical disease and identify patients suitable for surgery, conferring favourable outcomes. The short median TTR provides rationale to intensify imaging schedule in the first year of surveillance. The poor OS of patients treated with systemic therapy probably reflects the relatively inferior treatment options during this time and requires further evaluation in the current era.",

author = "Lim, {Kok Haw Jonathan} and Lavinia Spain and Claire Barker and Alexandros Georgiou and Gerard Walls and Martin Gore and Samra Turajlic and Ruth Board and Larkin, {James M} and Paul Lorigan",

year = "2018",

month = feb,

day = "24",

doi = "10.1136/esmoopen-2017-000317",

language = "English",

volume = "3",

journal = "ESMO Open",

issn = "2059-7029",

publisher = "BMJ Publishing Group",

}

TY - JOUR

T1 - Contemporary outcomes from the use of regular imaging to detect relapse in high-risk cutaneous melanoma

AU - Lim, Kok Haw Jonathan

AU - Spain, Lavinia

AU - Barker, Claire

AU - Georgiou, Alexandros

AU - Walls, Gerard

AU - Gore, Martin

AU - Turajlic, Samra

AU - Board, Ruth

AU - Larkin, James M

AU - Lorigan, Paul

PY - 2018/2/24

Y1 - 2018/2/24

N2 - Background Agreement on the utility of imaging followup in patients with high-risk melanoma is lacking. A UK consensus statement recommends a surveillance schedule of CT or positron-emission tomography-CT and MRI brain (every 6months for 3years, then annually in years 4 and 5) as well as clinical examination for high-risk resected Stages II and III cutaneous melanoma. Our aim was to assess patterns of relapse and whether imaging surveillance could be of clinical benefit. Patients and methods A retrospective study of patients enrolled between July 2013 and June 2015 from three UK tertiary cancer centres followed-up according to this protocol was undertaken. We evaluated time-to-recurrence (TTR), recurrence-free survival (RFS), method of detection and characteristics of recurrence, treatment received and overall survival (OS). Results A total of 173 patients were included. Most (79%) had treated Stages IIIB and IIIC disease. With a median follow-up of 23.3months, 82 patients (47%) had relapsed. Median TTR was 10.1months and median RFS was 21.2months. The majority of recurrences (66%) were asymptomatic and detected by scheduled surveillance scan. Fifty-six (68%) patients recurred with Stage IV disease, with a median OS of 25.3months; 26 (31.7%) patients had a locoregional recurrence, median OS not reached (P=0.016). Patients who underwent surgery at recurrence for either Stage III (27%) or IV (18%) disease did not reach their median OS. The median OS for the 33 patients (40%) who received systemic therapy was 12.9months. Conclusion Imaging appears to reliably detect subclinical disease and identify patients suitable for surgery, conferring favourable outcomes. The short median TTR provides rationale to intensify imaging schedule in the first year of surveillance. The poor OS of patients treated with systemic therapy probably reflects the relatively inferior treatment options during this time and requires further evaluation in the current era.

AB - Background Agreement on the utility of imaging followup in patients with high-risk melanoma is lacking. A UK consensus statement recommends a surveillance schedule of CT or positron-emission tomography-CT and MRI brain (every 6months for 3years, then annually in years 4 and 5) as well as clinical examination for high-risk resected Stages II and III cutaneous melanoma. Our aim was to assess patterns of relapse and whether imaging surveillance could be of clinical benefit. Patients and methods A retrospective study of patients enrolled between July 2013 and June 2015 from three UK tertiary cancer centres followed-up according to this protocol was undertaken. We evaluated time-to-recurrence (TTR), recurrence-free survival (RFS), method of detection and characteristics of recurrence, treatment received and overall survival (OS). Results A total of 173 patients were included. Most (79%) had treated Stages IIIB and IIIC disease. With a median follow-up of 23.3months, 82 patients (47%) had relapsed. Median TTR was 10.1months and median RFS was 21.2months. The majority of recurrences (66%) were asymptomatic and detected by scheduled surveillance scan. Fifty-six (68%) patients recurred with Stage IV disease, with a median OS of 25.3months; 26 (31.7%) patients had a locoregional recurrence, median OS not reached (P=0.016). Patients who underwent surgery at recurrence for either Stage III (27%) or IV (18%) disease did not reach their median OS. The median OS for the 33 patients (40%) who received systemic therapy was 12.9months. Conclusion Imaging appears to reliably detect subclinical disease and identify patients suitable for surgery, conferring favourable outcomes. The short median TTR provides rationale to intensify imaging schedule in the first year of surveillance. The poor OS of patients treated with systemic therapy probably reflects the relatively inferior treatment options during this time and requires further evaluation in the current era.

U2 - 10.1136/esmoopen-2017-000317

DO - 10.1136/esmoopen-2017-000317

M3 - Article

SN - 2059-7029

VL - 3

JO - ESMO Open

JF - ESMO Open

M1 - e000317

ER -

Contemporary outcomes from the use of regular imaging to detect relapse in high-risk cutaneous melanoma

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Biophysical correlates of base-mediated radiation cardiotoxicity in non-small cell lung cancer

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