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Lee TS, Li I, Peric B, Saw RPM, Duprat JP, Bertolli E, Spillane JB, van Leeuwen BL, Moncrieff M, Sommariva A, Allan CP, de Wilt JHW, Jones RP, Geh JLC, Howle JR, Spillane AJ. Leg Lymphoedema After Inguinal and Ilio-Inguinal Lymphadenectomy for Melanoma: Results from a Prospective, Randomised Trial. Ann Surg Oncol 2024; 31:4061-4070. [PMID: 38494565 PMCID: PMC11076360 DOI: 10.1245/s10434-024-15149-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2024] [Accepted: 02/14/2024] [Indexed: 03/19/2024]
Abstract
BACKGROUND The Evaluation of Groin Lymphadenectomy Extent for Melanoma (EAGLE FM) study sought to address the question of whether to perform inguinal (IL) or ilio-inguinal lymphadenectomy (I-IL) for patients with inguinal nodal metastatic melanoma who have no clinical or imaging evidence of pelvic disease. Primary outcome measure was disease-free survival at 5 years, and secondary endpoints included lymphoedema. METHODS EAGLE FM was designed to recruit 634 patients but closed with 88 patients randomised because of slow recruitment and changes in melanoma management. Lymphoedema assessments occurred preoperatively and at 6, 12, 18, and 24 months postoperatively. Lymphoedema was defined as Inter-Limb Volume Difference (ILVD) > 10%, Lymphoedema Index (L-Dex®) > 10 or change of L-Dex® > 10 from baseline. RESULTS Prevalence of leg lymphoedema between the two groups was similar but numerically higher for I-IL at all time points in the first 24 months of follow-up; highest at 6 months (45.9% IL [CI 29.9-62.0%], 54.1% I-IL [CI 38.0-70.1%]) and lowest at 18 months (18.8% IL [CI 5.2-32.3%], 41.4% I-IL [CI 23.5-59.3%]). Median ILVD at 24 months for those affected by lymphoedema was 14.5% (IQR 10.6-18.7%) and L-Dex® was 12.6 (IQR 9.0-17.2). There was not enough statistical evidence to support associations between lymphoedema and extent of surgery, radiotherapy, or wound infection. CONCLUSIONS Despite a trend for patients who had I-IL to have greater lymphoedema prevalence than IL in the first 24 months after surgery, our study's small sample did not have the statistical evidence to support an overall difference between the surgical groups.
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Affiliation(s)
- T S Lee
- Melanoma Institute Australia, Wollstonecraft, Sydney, Australia.
- Royal North Shore Hospital, Sydney, Australia.
- University of Sydney, Sydney, Australia.
| | - I Li
- Melanoma Institute Australia, Wollstonecraft, Sydney, Australia
- University of Sydney, Sydney, Australia
| | - B Peric
- Medical Faculty, Institute of Oncology Ljubljana, University of Ljubljana, Ljubljana, Slovenia
| | - R P M Saw
- Melanoma Institute Australia, Wollstonecraft, Sydney, Australia
- University of Sydney, Sydney, Australia
- Royal Prince Alfred Hospital, Sydney, Australia
- Mater Misericordiae Hospital, North Sydney, Australia
| | - J P Duprat
- AC Camargo Cancer Center, São Paulo, Brazil
| | - E Bertolli
- AC Camargo Cancer Center, São Paulo, Brazil
| | - J B Spillane
- Department of Surgical Oncology, Peter MacCallum Cancer Centre, Melbourne, Australia
| | - B L van Leeuwen
- Surgical Oncology, University Medical Center Groningen, Groningen, The Netherlands
| | - M Moncrieff
- Norfolk & Norwich University Hospital, Plastic and Reconstructive Surgery, Norwich, UK
| | - A Sommariva
- Veneto Institute of Oncology IOV-IRCCS, Surgical Oncology, Padua, Italy
| | - C P Allan
- Faculty of Medicine, Mater Clinic School, University of Queensland, Brisbane, Australia
| | - J H W de Wilt
- Department of Surgery, Radboud University Medical Center, Nijmegen, The Netherlands
| | - R Pritchard- Jones
- Mersey and West Lancashire Teaching Hospitals NHS Trust, Prescot, Knowsley, UK
| | - J L C Geh
- Department of Plastic and Reconstructive Surgery, St Thomas' Hospital, Guy's and St. Thomas' NHS Foundation Trust, London, UK
| | - J R Howle
- University of Sydney, Sydney, Australia
- Westmead Hospital, Sydney, Australia
| | - A J Spillane
- Melanoma Institute Australia, Wollstonecraft, Sydney, Australia
- Royal North Shore Hospital, Sydney, Australia
- University of Sydney, Sydney, Australia
- Mater Misericordiae Hospital, North Sydney, Australia
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2
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Lee TS, Li I, Peric B, Saw RPM, Duprat JP, Bertolli E, Spillane JB, van Leeuwen BL, Moncrieff M, Sommariva A, Allan C, de Wilt JHW, Pritchard-Jones R, Geh JLC, Howle JR, Spillane AJ. ASO Visual Abstract: Leg Lymphoedema After Inguinal and Ilio-Inguinal Lymphadenectomy for Melanoma: Results from a Prospective Randomized Trial. Ann Surg Oncol 2024:10.1245/s10434-024-15262-4. [PMID: 38637445 DOI: 10.1245/s10434-024-15262-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/20/2024]
Affiliation(s)
- T S Lee
- Melanoma Institute Australia, Sydney, Australia.
- Royal North Shore Hospital, Sydney, Australia.
- University of Sydney, Sydney, Australia.
| | - I Li
- Melanoma Institute Australia, Sydney, Australia
- University of Sydney, Sydney, Australia
| | - B Peric
- Institute of Oncology Ljubljana, Medical Faculty, University of Ljubljana, Ljubljana, Slovenia
| | - R P M Saw
- Melanoma Institute Australia, Sydney, Australia
- University of Sydney, Sydney, Australia
- Royal Prince Alfred Hospital, Sydney, Australia
- Mater Misericordiae Hospital, North Sydney, Australia
| | - J P Duprat
- AC Camargo Cancer Center, São Paulo, Brazil
| | - E Bertolli
- AC Camargo Cancer Center, São Paulo, Brazil
| | - J B Spillane
- Department of Surgical Oncology, Peter MacCallum Cancer Centre, Melbourne, Australia
| | - B L van Leeuwen
- Surgical Oncology, University Medical Center Groningen, Groningen, The Netherlands
| | - M Moncrieff
- Plastic and Reconstructive Surgery, Norfolk and Norwich University Hospital, Norwich, UK
| | - A Sommariva
- Veneto Institute of Oncology IOV-IRCCS, Surgical Oncology, Padua, Italy
| | - C Allan
- Mater Clinic School, Faculty of Medicine, University of Queensland, Brisbane, Australia
| | - J H W de Wilt
- Department of Surgery, Radboud University Medical Center, Nijmegen, The Netherlands
| | - R Pritchard-Jones
- Mersey and West Lancashire Teaching Hospitals NHS Trust, Prescot, Knowsley, UK
| | - J L C Geh
- Department of Plastic and Reconstructive Surgery, Guy's and St. Thomas' NHS Foundation Trust, St Thomas' Hospital, London, UK
| | - J R Howle
- University of Sydney, Sydney, Australia
- Westmead Hospital, Sydney, Australia
| | - A J Spillane
- Melanoma Institute Australia, Sydney, Australia
- Royal North Shore Hospital, Sydney, Australia
- University of Sydney, Sydney, Australia
- Mater Misericordiae Hospital, North Sydney, Australia
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de Menezes JN, Arra DASM, Lôbo MM, Pinto CAL, Lima JPSN, Silva MJB, Duprat Neto JP, Bertolli E. Recurrence Patterns and Clinical Management after a Positive Sentinel Node Biopsy in Melanoma Patients. Cancer Invest 2023; 41:830-836. [PMID: 37962565 DOI: 10.1080/07357907.2023.2283459] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2021] [Accepted: 11/09/2023] [Indexed: 11/15/2023]
Abstract
Introduction melanoma patients who become stage III after a positive sentinel node biopsy (SNB) may have several patterns of recurrence patients and methods retrospective analysis of melanoma patients who have undergone SNB in a single institution from 2000 to 2015. Results There were 111 recurrences (45.1%) among 246 (20.3%) SNB positive patients and median DRFS was 77.7 months. After initial treatment, further recurrences occurred in 68 (77.3%) patients, regardless the site of initial recurrence conclusions multimodal strategies are recommended to achieve better results when managing stage III melanoma patients after a positive SNB.
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Affiliation(s)
| | - Dante A S M Arra
- Surgical Oncology Residence Program, A.C. Camargo Cancer Center, São Paulo, SP, Brazil
| | - Matheus M Lôbo
- Skin Cancer Department, A.C. Camargo Cancer Center, São Paulo, SP, Brazil
| | | | | | | | - João P Duprat Neto
- Skin Cancer Department, A.C. Camargo Cancer Center, São Paulo, SP, Brazil
| | - Eduardo Bertolli
- Skin Cancer Department, A.C. Camargo Cancer Center, São Paulo, SP, Brazil
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Sortino AMF, Soares de Sá BC, Martins MA, Bertolli E, de Paula RB, Lopes Pinto CA, David Filho WJ, Tavoloni Braga JC, Duprat Neto JP, Carraro DM, Curado MP. Multiple Primary Melanoma: A Five-Year Prospective Single-Center Follow-Up Study of Two MC1R R/R Genotype Carriers. Life (Basel) 2023; 13:2102. [PMID: 37895483 PMCID: PMC10608495 DOI: 10.3390/life13102102] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2023] [Revised: 10/10/2023] [Accepted: 10/15/2023] [Indexed: 10/29/2023] Open
Abstract
BACKGROUND Multiple primary melanoma (MPM) is a diagnostic challenge even with ancillary imaging technologies available to dermatologists. In selected patients' phenotypes, the use of imaging approaches can help better understand lesion characteristics, and aid in early diagnosis and management. METHODS Under a 5-year prospective single-center follow-up, 58 s primary melanomas (SPMs) were diagnosed in two first-degree relatives, with fair skin color, red hair, green eyes, and personal history of one previous melanoma each. Patients' behavior and descriptive demographic data were collected from medical records. The information on the first two primary melanomas (PMs) were retrieved from pathology reports. The characteristics of 60 melanomas were collected from medical records, video dermoscopy software, and pathology reports. Reflectance confocal microscopy (RCM) was performed prior to excision of 22 randomly selected melanomas. RESULTS From February 2018 to May 2023, two patients underwent a pooled total of 214 excisional biopsies of suspect lesions, resulting in a combined benign versus malignant treatment ratio (NNT) of 2.0:1.0. The number of moles excised for each melanoma diagnosed (NNE) was 1.7:1.0 and 6.9:1.0 for the female and male patient respectively. The in-situ melanoma/invasive melanoma ratio (IIR) demonstrated a higher proportion of in-situ melanomas for both patients. From June 2018 to May 2023, a total of 58 SPMs were detected by the combination of total body skin exam (TBSE), total body skin photography (TBSP), digital dermoscopy (DD), and sequential digital dermoscopy imaging (SDDI) via comparative approach. The younger patient had her PM one month prior to the second and third cutaneous melanomas (CMs), characterizing a case of synchronous primary CM. The male older relative had a total of 7 nonsynchronous melanomas. CONCLUSIONS This CM cohort is composed of 83.3% in-situ melanoma and 16.7% invasive melanoma. Both patients had a higher percentage of SPM with clinical nevus-like morphology (84.5%), global dermoscopic pattern of asymmetric multiple component (60.3%) and located on the lower limbs (46.6%). When RCM was performed prior to excision, 81% of SPM had features suggestive of malignancy. As well, invasive melanomas were more frequent in the lower limbs (40%). In the multivariate model, for the two high-risk patients studied, the chance of a not associated with nevus ("de novo") invasive SPM diagnosis is 25 times greater than the chance of a diagnosis of a nevus-associated invasive SPM.
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Affiliation(s)
- Ana Maria Fagundes Sortino
- Clínica Dermatológica Dermatis, Rua Joaquim Floriano 466, Itaim Bibi, São Paulo 04534-002, SP, Brazil
- Hospital Sírio-Libanês, Rua Dona Adma Jafet 115, Bela Vista, São Paulo 01308-050, SP, Brazil
| | | | - Marcos Alberto Martins
- Centro Universitário Saúde ABC, Surgery Department, Avenida Lauro Gomes 2000, Vila Sacadura Cabral, Santo André 09060-870, SP, Brazil
| | - Eduardo Bertolli
- Hospital Sírio-Libanês, Rua Dona Adma Jafet 115, Bela Vista, São Paulo 01308-050, SP, Brazil
- A Beneficência Portuguesa de São Paulo–BP Mirante, Rua Martiniano de Carvalho 965, Bela Vista, São Paulo 01323-001, SP, Brazil
| | - Rafaela Brito de Paula
- AC Camargo Cancer Center, Rua Pires da Mota 1.167, Aclimação, São Paulo 01529-001, SP, Brazil
| | | | - Waldec Jorge David Filho
- Hospital Alemão Oswaldo-Cruz, Rua Treze de Maio 1815, Bela Vista, São Paulo 01323-903, SP, Brazil;
| | | | | | - Dirce Maria Carraro
- AC Camargo Cancer Center, Rua Pires da Mota 1.167, Aclimação, São Paulo 01529-001, SP, Brazil
| | - Maria Paula Curado
- AC Camargo Cancer Center, Rua Pires da Mota 1.167, Aclimação, São Paulo 01529-001, SP, Brazil
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5
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de Barros E Silva MJ, Teixeira MR, Lobo MDM, Molina AS, Bertolli E, Santos Filho IDDAO, Castro Ribeiro HS, Pelizon ACDA, Lopes Pinto CA, Duprat Neto JP. Local therapy in advanced melanoma after immune checkpoint inhibitors aiming to achieve complete response. J Cancer Res Ther 2023; 19:1272-1278. [PMID: 37787295 DOI: 10.4103/jcrt.jcrt_1684_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/04/2023]
Abstract
Background and Objectives New scenarios for local therapy have arisen after starting immune checkpoint inhibitors (ICIs) to treat advanced melanoma (AM). The aim of this study is to examine the role of local therapies with curative intention for patients with AM that have been on ICI. Methods This was a single institution, retrospective analysis of unresectable stage III or IV melanoma patients on treatment with anti-PD1 ± anti-CTLA-4 who underwent local therapy with curative intention with no other remaining sites of disease (NRD). Results Of the 170 patients treated with ICI, 19 (11.2%) met the criteria of curative intention. The median time on ICI before local therapy was 16.6 months (range: 0.92-43.2). At the time of the local treatment, the disease was controlled in 16 (84.25%) and progressing in 3 patients (15.75%); 14 patients (73.7%) treated a single lesion and 5 (26.3%) treated 2 to 3 lesions. In a median follow-up of 17 months (range: 1.51-38.2) after the local therapy and 9.8 months after the last ICI cycle (range: 0.56-31), only 2 (10.5%) out of 19 patients relapsed. Conclusions Patients with AM on treatment with ICI were able to achieve NRD after local treatment and may benefit from long-term disease control without systemic treatment.
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Affiliation(s)
| | | | | | - André Sapata Molina
- Department of Surgical Oncology, AC Camargo Cancer Center, São Paulo, Brazil
| | - Eduardo Bertolli
- Department of Surgical Oncology, AC Camargo Cancer Center, São Paulo, Brazil
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6
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Gómez YM, Gallardo DI, Bourguignon M, Bertolli E, Calsavara VF. A general class of promotion time cure rate models with a new biological interpretation. Lifetime Data Anal 2023; 29:66-86. [PMID: 36114312 DOI: 10.1007/s10985-022-09575-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/28/2021] [Accepted: 08/30/2022] [Indexed: 06/15/2023]
Abstract
Over the last decades, the challenges in survival models have been changing considerably and full probabilistic modeling is crucial in many medical applications. Motivated from a new biological interpretation of cancer metastasis, we introduce a general method for obtaining more flexible cure rate models. The proposal model extended the promotion time cure rate model. Furthermore, it includes several well-known models as special cases and defines many new special models. We derive several properties of the hazard function for the proposed model and establish mathematical relationships with the promotion time cure rate model. We consider a frequentist approach to perform inferences, and the maximum likelihood method is employed to estimate the model parameters. Simulation studies are conducted to evaluate its performance with a discussion of the obtained results. A real dataset from population-based study of incident cases of melanoma diagnosed in the state of São Paulo, Brazil, is discussed in detail.
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Affiliation(s)
- Yolanda M Gómez
- Departamento de Medicina, Facultad de Medicina, Universidad de Atacama, Copiapó, Chile
| | - Diego I Gallardo
- Departamento de Medicina, Facultad de Medicina, Universidad de Atacama, Copiapó, Chile
- Departamento de Matemática, Facultad de Ingeniería, Universidad de Atacama, Copiapó, Chile
| | - Marcelo Bourguignon
- Departamento de Estatística, Universidade Federal do Rio Grande do Norte, Natal, RN, 59078-970, Brazil.
| | - Eduardo Bertolli
- Skin Cancer Department, A.C.Camargo Cancer Center, São Paulo, SP, Brazil
- Oncology Center, Beneficência Portuguesa, São Paulo, SP, Brazil
| | - Vinicius F Calsavara
- Biostatistics and Bioinformatics Research Center, Cedars-Sinai Medical Center, Los Angeles, CA, USA
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7
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Munhoz RR, Nader-Marta G, de Camargo VP, Queiroz MM, Cury-Martins J, Ricci H, de Mattos MR, de Menezes TAF, Machado GUC, Bertolli E, Barros M, de Souza CE, Franke F, Ferreira FO, Feher O, de Castro G. A phase 2 study of first-line nivolumab in patients with locally advanced or metastatic cutaneous squamous-cell carcinoma. Cancer 2022; 128:4223-4231. [PMID: 36274573 DOI: 10.1002/cncr.34463] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2022] [Revised: 05/01/2022] [Accepted: 05/23/2022] [Indexed: 01/31/2023]
Abstract
BACKGROUND Cutaneous squamous-cell carcinoma (CSCC) is among the most frequent malignancies worldwide. For those not amenable to treatment with curative intent, immune checkpoint inhibition (ICI) with anti-programmed death receptor 1 (PD-1) antibodies has emerged as a novel therapeutic option. In this study, the authors sought to investigate the activity of the anti-PD-1 agent nivolumab in patients with advanced CSCC (aCSCC). METHODS CA209-9JC was an open-label, single-arm, phase 2 study to evaluate the safety and/or efficacy of nivolumab in systemic treatment-naive patients with aCSCC. Nivolumab (3 mg/kg) was administered every 2 weeks until disease progression, unacceptable toxicity, or 12 months of treatment. The primary end point was the best objective response rate (BORR) as per RECIST 1.1 criteria. Secondary end points included safety, progression-free survival (PFS), and overall survival (OS). RESULTS Twenty-four patients with aCSCC were enrolled with a median age of 74 years (range, 48-93). Among the 24 patients evaluable for response, the BORR was 58.3% (14/24); there were no complete responses. With a median follow-up of 17.6 months, median duration of response has not been reached, and the estimated median PFS and OS were 12.7 and 20.7 months, respectively. Prior exposure to radiotherapy was associated with worse outcomes (p = .035, univariate analysis). Treatment-related adverse events of any grade and grade ≥ 3 occurred in 21 (87.5%) and six (25%) patients, respectively, and one patient discontinued nivolumab due to toxicities. CONCLUSIONS Nivolumab resulted in robust antitumor activity, sustained responses, and good tolerability in systemic treatment-naive patients with aCSCC. These data provide further evidence to support the use of ICI as the standard treatment of aCSCC.
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Affiliation(s)
- Rodrigo R Munhoz
- Oncology Service, Instituto do Câncer do Estado de São Paulo, Hospital das Clínicas HCFMUSP, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil.,Oncology Center, Hospital Sírio Libanês, São Paulo, Brazil
| | | | - Veridiana P de Camargo
- Centro de Oncologia e Hematologia, Beneficiência Portuguesa de São Paulo, São Paulo, Brazil
| | | | - Jade Cury-Martins
- Dermatology Department, Hospital das Clínicas HCFMUSP, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil
| | - Hermínia Ricci
- Oncology Service, Instituto do Câncer do Estado de São Paulo, Hospital das Clínicas HCFMUSP, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil
| | - Marcela R de Mattos
- Oncology Service, Instituto do Câncer do Estado de São Paulo, Hospital das Clínicas HCFMUSP, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil
| | | | - Guilherme U C Machado
- Oncology Division, Hospital das Clínicas da Universidade de São Paulo, Ribeirão Preto, Brazil
| | - Eduardo Bertolli
- Oncology Center, Hospital Sírio Libanês, São Paulo, Brazil.,Centro de Oncologia e Hematologia, Beneficiência Portuguesa de São Paulo, São Paulo, Brazil.,Skin Cancer Department, A.C. Camargo Cancer Center, São Paulo, São Paulo, Brazil
| | - Milton Barros
- Skin Cancer Department, A.C. Camargo Cancer Center, São Paulo, São Paulo, Brazil
| | | | - Fábio Franke
- Oncosite, Centro De Pesquisa Clínica Em Oncologia, Ijuí, Brazil
| | - Fabio O Ferreira
- Oncology Service, Instituto do Câncer do Estado de São Paulo, Hospital das Clínicas HCFMUSP, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil.,Oncology Center, Hospital Sírio Libanês, São Paulo, Brazil
| | - Olavo Feher
- Oncology Service, Instituto do Câncer do Estado de São Paulo, Hospital das Clínicas HCFMUSP, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil.,Oncology Center, Hospital Sírio Libanês, São Paulo, Brazil
| | - Gilberto de Castro
- Oncology Service, Instituto do Câncer do Estado de São Paulo, Hospital das Clínicas HCFMUSP, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil.,Oncology Center, Hospital Sírio Libanês, São Paulo, Brazil
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8
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Otsuka ACVG, Bertolli E, de Macedo MP, Pinto CAL, Duprat Neto JPD. Intraoperative assessment of surgical margins using "en face" frozen sections in the management of cutaneous carcinomas. An Bras Dermatol 2022; 97:583-591. [PMID: 35803765 PMCID: PMC9453531 DOI: 10.1016/j.abd.2021.09.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2021] [Revised: 09/18/2021] [Accepted: 09/20/2021] [Indexed: 11/24/2022] Open
Abstract
Background Basal cell and squamous cell carcinomas (BCC and SCC) are the most common types of cancer worldwide. Intraoperative assessment of surgical margins by frozen section has been widely used to ensure disease-free margins. The intraoperative “en face” freezing technique evaluates all peripheral and deep margins. Objective To report the results of the “en face” freezing technique in relation to tumor recurrence and agreement with paraffin-embedded tissue examination. Methods Retrospective analysis of patients undergoing surgical excision of BCC and SCC at the A. C. Camargo Cancer Center, Brazil. Results This study included 542 skin carcinomas, which were excised from 397 patients. A total of 201 male patients (50.6%), and 196 female patients (49.4%) were assessed, whose mean age was 64 years. The tumors were mostly located on the head and neck region (87.8%). BCC corresponded to 79.7% of the cases. The mean follow-up was 38 months. Tumor relapse occurred in 0.86% of the primary tumors and 3.7% of recurrent tumors. The result of the intraoperative “en face” frozen section evaluation was in agreement with the final result of the anatomopathological examination (paraffin test) in 98% of the lesions. Study limitations Not having a minimum follow-up time of 5 years for all patients. Conclusion The “en face” freezing technique shows low tumor relapse, being reliable and safe to guarantee negative surgical margins of the tumor.
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Affiliation(s)
| | - Eduardo Bertolli
- Department of Cutaneous Oncology, A. C. Camargo Cancer Center, São Paulo, SP, Brazil
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9
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Queiroz MM, Bertolli E, Belfort FA, Munhoz RR. Management of In-Transit Metastases. Curr Oncol Rep 2022; 24:573-583. [PMID: 35192119 DOI: 10.1007/s11912-022-01216-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/05/2021] [Indexed: 11/30/2022]
Abstract
PURPOSE OF REVIEW The purpose of this study is to discuss the current knowledge and future perspectives regarding the treatment options for in-transit metastases (ITM), along with the optimal algorithms for patients presenting with this adverse manifestation of melanoma. RECENT FINDINGS In addition to procedures historically accepted for the management of ITM, encompassing surgery and regional techniques, novel medications in the form of immune checkpoint inhibitors (ICI) and targeted therapies now represent standard options, allowing for the possibility of combined approaches, with an expanding role of systemic therapies. Melanoma in-transit metastases consist of intralymphatic neoplastic implants distributed between the primary site and the regional nodal basin, within the subepidermal and dermal lymphatics. Distinct risk factors may influence the development of ITM, and the clinical presentation can be highly heterogeneous, enhancing the complexity of the management of ITM. Surgical resection, when feasible, continues to represent a standard approach for patients with curative intent. Patients with extensive or unresectable disease may also benefit from regional approaches that include isolated limb perfusion or infusion, electrochemotherapy, and a wide variety of intralesional therapies. Over the past decade, regimens with ICI and BRAF/MEK inhibitors dramatically expanded the benefit of systemic treatments for patients with melanoma, both in the adjuvant setting and for those with advanced disease, and the combination of these modalities with regional treatments, as well as neoadjuvant approaches, may represent the future for the treatment of patients with ITM.
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Affiliation(s)
| | - Eduardo Bertolli
- Cutaneous Oncology and Sarcomas Group, Hospital Sírio Libanês, São Paulo, Brazil.,Skin Cancer Department, AC Camargo Cancer Center, São Paulo, Brazil.,Melanoma and Sarcoma Group, Beneficência Portuguesa de São Paulo, São Paulo, Brazil
| | | | - Rodrigo Ramella Munhoz
- Oncology Center, Hospital Sírio Libanês, São Paulo, Brazil. .,Cutaneous Oncology and Sarcomas Group, Hospital Sírio Libanês, São Paulo, Brazil.
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10
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Ramella Munhoz R, de Camargo V, Nader Marta G, Queiroz M, Cury-Martins J, Nardo M, Chaul-Barbosa C, Ricci H, de Mattos M, de Menezes T, Machado G, Bertolli E, Barros M, Franke F, Ferreira F, Feher O, de Castro G. 1064P Final results of CA209-9JC: A phase II study of first-line nivolumab in patients with advanced cutaneous squamous cell carcinoma. Ann Oncol 2021. [DOI: 10.1016/j.annonc.2021.08.1449] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
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Wainstein AJA, Duprat Neto JP, Enokihara MY, Brechtbühl ER, Riccardi F, Landman G, de Melo AC, de Lima Vazquez V, Munhoz RR, Dunshee De Abranches Oliveira Santos Filho I, Bertolli E, Drummond-Lage AP, Costa Soares de Sá B, Botelho L, Higino Steck J, Belfort FA, Maia M, Bakos RM, Gomes EE, Schmerling R, Cavarsan F. Demographic, Clinical, and Pathologic Features of Patients With Cutaneous Melanoma: Final Analysis of the Brazilian Melanoma Group Database. JCO Glob Oncol 2021; 6:575-582. [PMID: 32293941 PMCID: PMC7193775 DOI: 10.1200/jgo.20.00005] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
PURPOSE National epidemiologic data on melanoma are scarce in Brazil. The current work presents final demographic, clinical, and pathologic results from the Brazilian Melanoma Group database to detail how patients with melanoma present at diagnosis. METHODS The online database includes patients diagnosed between 1982 and 2015 and evaluated at their centers of origin between 2001 and 2016. The primary objective was to describe the demographic, clinical, and pathologic characteristics of the patients, and secondary objectives were to investigate the association between clinical and pathologic variables of interest. RESULTS A total of 1,596 patients were included. Median age was 52 years, 57% were women, and the majority were identified as white. Invasive melanoma was diagnosed in 1,297 patients, mostly localized, whereas 299 (19%) had in situ disease (TisN0M0). Only 165 patients had initial lymph node involvement. Fitzpatrick skin types I or II were slightly more frequent with in situ melanoma (73%) than with invasive disease (67%; P = .054). The median Breslow thickness was 0.95 mm, Clark levels 2 and 3 comprised nearly 70% of cases, and ulceration was present in 18% of patients. The mitotic rate was significantly associated with the presence of ulceration and both vascular and perineural invasion but not with margin positivity, whereas histologic regression was associated with both intratumoral and peritumoral inflammatory infiltrates. CONCLUSION Despite the limitations of an observational, registry-based study, the current results provide a general profile of patients with cutaneous melanoma in Brazil at the time of diagnosis.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | - Marcus Maia
- Brazilian Melanoma Group, São Paulo, São Paulo, Brazil
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12
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De Barros E. Silva MJ, Liz CD, Teixeira MR, Rinck JA, Tavares MC, Garcia D, Lima JPSN, Lobo M, Pinto C, Cavicchioli M, Lima E, Bertolli E, Molina A, Gollob K, Figueiredo A, Duprat J. FDG-PET/CT response and outcome of neoadjuvant immunotherapy for clinical stage III melanoma. J Clin Oncol 2021. [DOI: 10.1200/jco.2021.39.15_suppl.e21569] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
e21569 Background: Neoadjuvant immunotherapy with nivolumab 3mg/kg and ipilimumab 1mg/kg for two cycles(N3+I1) or anti-PD1 for 3-8 weeks for clinical stage III melanoma have shown rates of pCR/near-pCR about 60% or 30%, respectively. The prognosis of this group seems to be excellent so far. On the other hand, patients classified as pathological non-response have a worse outcome and early identification of this group may allow us to tailor treatment before surgery. Methods: We conducted a retrospective analysis of patients with clinical stage III melanoma treated with neoadjuvant immune checkpoint blockade who did baseline and pre-operative FDG-PET/CT. The total number of FGD avid lesions and the percentual difference between the maximum SUV per lesion was calculated. The pathological results were correlated to FGD-PET/CT findings. Results: Between January 2019 and January 2021, nine patients with clinical stage III melanoma were identified. Six patients received Nivolumab 3m/kg and Ipilimumab 1mg/kg for two cycles and 3 received anti-PD1 for 60 days. Baseline FDG-PET/CT showed just one avid lesion in 7 patients, 2 avid lesions in one patient and 3 avid lesions in one patient. All known lesions identified by CT scan were also captured by FGD-PET/CT. After the neoadjuvant treatment, 4 patients achieved pCR/near-pCR. All of them were treated with N3+I1. Two of them had metabolic complete response (including the one with 3 PET- avid lesions) and 2 had reduction on FDG concentration (-31% and – 76%). Three patients had absence of response: 100% of viable tumor cells (VTC), all of them with increase in FDG concentration (+12% to + 307%) and appearance of a new lesion in one case. Two out of them were treated with anti-PD1. One patient had partial response (40% of VTC). Interestingly, this patient developed sarcoidosis-like reaction with increase of SUV in the index lesion (+68%) and appearance of mediastinal lymph-nodes. One patient, who had two lesions, presented a mixed response: complete response in one and 90% of VTC in the other. FDG-PET/CT was able to detect both responses (metabolic complete response and increase of FGD concentration of 17%, respectively). Conclusions: Reduction in FGD-PET/CT concentration with no appearance of new lesion(s) is associated with significant pathological response. An increase of SUV or appearance of new lesion(s) should be carefully interpreted.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | | | | | | | | | - Kenneth Gollob
- AC Carmargo Cancer Center-Translational Immunology Group, São Paulo, Brazil
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13
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Favareto SL, Pellizzon ACA, Lopes Pinto CA, Bertolli E, Castro DG. The Role of Radiation Therapy as an Adjuvant Treatment in Nodal Metastasis of Malignant Chondroid Syringoma. Cureus 2020; 12:e11360. [PMID: 33304693 PMCID: PMC7720919 DOI: 10.7759/cureus.11360] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
Malignant chondroid syringomas (MCSs) are extremely rare and aggressive skin tumors, and wide surgical excision is the main treatment. They can progress with local recurrence and nodal and distant metastasis. The role of radiotherapy is uncertain, but may enhance local control after surgical approach. We report a case of a 60-year-old female with this disease that, four years after surgical resection, presented with nodal metastasis and was managed with surgery and adjuvant radiotherapy.
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Affiliation(s)
- Sergio L Favareto
- Radiation Oncology, Antônio Cândido de Camargo Cancer Center, São Paulo, BRA
| | | | | | - Eduardo Bertolli
- Skin Cancer Department, Antônio Cândido de Camargo Cancer Center, São Paulo, BRA
| | - Douglas G Castro
- Radiation Oncology, Antônio Cândido de Camargo Cancer Center, São Paulo, BRA
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Bertolli E, Calsavara VF, de Macedo MP, Pinto CAL, Duprat Neto JP. Development and validation of a Brazilian nomogram to assess sentinel node biopsy positivity in melanoma. Tumori 2020; 107:440-445. [PMID: 33143554 DOI: 10.1177/0300891620969827] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Although well-established, sentinel node biopsy (SNB) for melanoma is not free from controversies and sometimes it can be questionable if SNB should be considered even for patients who meet the criteria for the procedure. Mathematical tools such as nomograms can be helpful and give more precise answers for both clinicians and patients. We present a nomogram for SNB positivity that has been internally validated. METHODS Retrospective analysis of patients who underwent SNB from 2000 to 2015 in a single institution. Single logistic regressions were used to identify variables that were associated to SNB positivity. All variables with a p value < 0.05 were included in the final model. Overall performance, calibration, and discriminatory power of the final multiple logistic regression model were all assessed. Internal validation of the multiple logistic regression model was performed via bootstrap analysis based on 1000 replications. RESULTS Site of primary lesion, Breslow thickness, mitotic rate, histologic regression, lymphatic invasion, and Clark level were statistically related to SNB positivity. After internal validation, a good performance was observed as well as an adequate power of discrimination (area under the curve 0.751). CONCLUSIONS We have presented a nomogram that can be helpful and easily used in daily practice for assessing SNB positivity.
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Affiliation(s)
- Eduardo Bertolli
- Skin Cancer Department, A.C. Camargo Cancer Center, São Paulo, Brazil
| | - Vinicius F Calsavara
- Statistics and Epidemiology Department, A.C. Camargo Cancer Center, São Paulo, Brazil
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15
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Antonialli AZ, Bertolli E, de Macedo MP, Pinto CAL, Calsavara VF, Neto JPD. How does the mitotic index impact patients with T1 melanoma? Comparison between the 7th and 8th edition of the American Joint Committee on Cancer melanoma staging system. An Bras Dermatol 2020; 95:691-695. [PMID: 33008658 PMCID: PMC7672494 DOI: 10.1016/j.abd.2020.03.020] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2019] [Accepted: 03/10/2020] [Indexed: 11/07/2022] Open
Abstract
Background The mitotic index is no longer used to classify T1 melanoma patients into T1a and T1b, so it should not be used to indicate sentinel node biopsy in these patients. Objectives To evaluate patients with T1 melanoma who underwent sentinel lymph node biopsy and to compare those who were classified as T1a with those classified T1b, according to the 7th and 8th Edition of the melanoma staging system, regarding a positive biopsy result. The authors also aimed to assess whether there is any difference in the results in both staging systems. Material and methods This was a retrospective analysis of 1213 patients who underwent sentinel lymph node biopsy for melanoma, from 2000 to 2015, in a single institution. Results Of 399 patients with thin melanomas, 27 (6.7%) presented positive sentinel lymph nodes; there was no difference in positivity for sentinel node biopsy when comparing T1a vs. T1b in both staging systems. Furthermore, the clinical results were also similar between the two groups. However, in the complete cohort analysis, the mitotic index was associated with positivity for sentinel lymph node biopsy (p < 0.0001), positivity for non-sentinel lymph node (p < 0.0001), recurrence-free survival (p < 0.0001), and specific melanoma survival (p = 0.023). Study limitation Unicentric study. Conclusion The mitotic index was shown to be a very important prognostic factor in the present study, but it was not observed in patients classified as T1. The mitotic index should no longer be used as the only reason to refer sentinel lymph node biopsy in patients with thin melanoma.
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Fonseca IB, Lindote MVN, Monteiro MR, Doria Filho E, Pinto CAL, Jafelicci AS, de Melo Lôbo M, Calsavara VF, Bertolli E, Duprat Neto JP. Sentinel Node Status is the Most Important Prognostic Information for Clinical Stage IIB and IIC Melanoma Patients. Ann Surg Oncol 2020; 27:4133-4140. [PMID: 32767223 DOI: 10.1245/s10434-020-08959-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2020] [Accepted: 07/02/2020] [Indexed: 12/23/2022]
Abstract
BACKGROUND Sentinel node biopsy (SNB) for melanoma patients has been questioned. We aimed to study high-risk stage II melanoma patients who underwent SNB to determine what the prognostic factors regarding recurrence and mortality were, and evaluate how relevant SNB status is in this scenario. METHODS This was a retrospective analysis of clinical stage IIB/IIC melanoma patients who underwent SNB from 2000 to 2015 in a single institution. Prognostic factors related to distant recurrence-free survival (DRFS) and melanoma-specific survival (MSS) were assessed from multiple Cox regression. Relevant variables were used to create risk predictor nomograms for DRFS and MSS. RESULTS From 1213 SNB, 259 were performed for clinical stage IIB/IIC melanoma patients. SNB status was the most important variable for both endpoints. Patients with positive SNB presented median DRFS of 35.73 months (95% CI 21.38-50.08, SE 7.32) and median MSS of 66.4 months (95% CI 29.76-103.03, SE 18.69), meanwhile both median DRFS and MSS were not achieved for those with negative SNB (logrank < 0.0001). Both nomograms have been internally validated and presented adequate calibration (C-index was 0.734 for DRFS and 0.718 for MSS). CONCLUSIONS SNB status was the most important risk factor in our cohort of clinical stage IIB and IIC patients and, in conjunction with well-established primary tumor characteristics, should not be abandoned. Their use in prognosis for these patients remains extremely useful for daily practice.
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Affiliation(s)
| | | | | | | | | | | | | | | | - Eduardo Bertolli
- Skin Cancer Department, A. C. Camargo Cancer Center, São Paulo, SP, Brazil.
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17
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Bertolli E, Calsavara VF. ASO Author Reflections: Sentinel Node Biopsy-Retirement Will Have to Wait. Ann Surg Oncol 2020; 27:4141-4142. [PMID: 32737695 DOI: 10.1245/s10434-020-08962-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2020] [Accepted: 07/10/2020] [Indexed: 11/18/2022]
Affiliation(s)
- Eduardo Bertolli
- Skin Cancer Department, A.C. Camargo Cancer Center, São Paulo, SP, Brazil.
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18
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van Veenendaal LM, Bertolli E, Korse CM, Klop WMC, Tesselaar MET, van Akkooi ACJ. The Clinical Utility of Neuron-Specific Enolase (NSE) Serum Levels as a Biomarker for Merkel Cell Carcinoma (MCC). Ann Surg Oncol 2020; 28:1019-1028. [PMID: 32529274 DOI: 10.1245/s10434-020-08656-7] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2019] [Indexed: 12/16/2022]
Abstract
BACKGROUND No adequate biomarker for Merkel cell carcinoma (MCC) has been identified. Serum neuron-specific enolase (NSE) has been tested and is commonly used as a biomarker for several other small cell malignancies. However, the role of NSE in MCC is still unclear. The purpose of this study was to investigate the role of NSE as a biomarker in MCC. METHODS A prospective cohort of MCC patients was analyzed using Kaplan-Meier curves with log-rank test, ROC curves, Cox regression, and mixed models. A separate evaluation was performed for patients treated with immunotherapy. RESULTS Eighty-four patients were included [47 males, median age 71 years, stages I & II, III, and IV MCC in respectively 39 (46%), 42 (50%), and 4 (3%) patients at time of diagnosis] with 565 NSE samples (median 15; interquartile range 12.6-22 ng/ml). Baseline NSE had no association with prognosis. NSE correlated with extent of disease (P = 0.01) and increased with 15 ng/ml per class (no tumor load, localized MCC, regional or distant metastases, respectively). NSE was able to detect progression (AUC 0.89). A NSE of 18.2 ng/ml was considered the most optimal level for clinical use (sensitivity 91%, specificity 78%, PPV 48%, NPV 98%). During immunotherapy (N = 23; 248 NSE values), all complete responders (N = 10) had a normalized NSE (< 18.2 ng/ml), all partial responders (N = 5) had a decreasing NSE. In nonresponders (N = 8), all NSE levels remained elevated. CONCLUSIONS NSE could be a valuable biomarker in MCC. NSE correlates with extent of disease; it is able to rule out progression and distinguishes responders from nonresponders during immunotherapy.
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Affiliation(s)
- Linde M van Veenendaal
- Department of Medical Oncology, Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Eduardo Bertolli
- Department of Surgical Oncology, Netherlands Cancer Institute, Amsterdam, The Netherlands.,Skin Cancer Department, AC Camargo Cancer Center, São Paulo, SP, Brazil
| | - Catharina M Korse
- Department of Clinical Chemistry, Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - W Martin C Klop
- Department of Head and Neck Surgery, Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Margot E T Tesselaar
- Department of Medical Oncology, Netherlands Cancer Institute, Amsterdam, The Netherlands
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19
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Munhoz RR, Camargo VPD, Marta GN, Martins JC, Nardo M, Barbosa CC, de Souza CE, Barbosa I, Ricci H, de Mattos MR, Menezes T, Machado GU, Bertolli E, Barros MJ, Franke FA, Feher O, Castro G. CA209-9JC: A phase II study of first-line nivolumab (NIVO) in patients (pts) with locally advanced or metastatic cutaneous squamous cell carcinoma. J Clin Oncol 2020. [DOI: 10.1200/jco.2020.38.15_suppl.10044] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
10044 Background: Cutaneous squamous cell carcinoma (cSCC) is among the most frequent malignancies worldwide, and an increasing incidence has been documented over the past decades. For those not amenable to treatment with curative intent, immune checkpoint blockade (ICP) with anti-PD-1 monoclonal antibodies emerged as a novel therapeutic option, supported by evidences of high mutational burden and expression of PD-L1. In this single-arm study, we sought in investigate the activity of NIVO in pts with advanced cSCC (AcSCC). Methods: We conducted a Simon two-stage, open-label, phase II study to evaluate the safety/efficacy of NIVO for up to 24 systemic-treatment-naïve pts with metastatic and/or locaally advanced cSCC. NIVO at 3mg/kg was administered intravenously every 2 weeks (w) until disease progression, unacceptable toxicity or 12 months of treatment. The primary endpoint was the best objective response rate (bORR) at 24w as per RECIST criteria. Tumor measurements were performed every 12w. Secondary endpoints included safety/tolerability, progression-free survival (PFS) and overall survival (OS). Results: Between October 2018 and October 2019, 24 pts with AcSCC were enrolled, with a median age of 74 years (range 48-93) and a male/female ratio of 1.4:1. Most frequent primary sites were head/neck (42%), trunk (29%) and extremities (25%); identified risk factors included chronic sun exposure or burn scars in 66 % and 12.5 %, respectively. Upon enrolment, the proportions of patients with locally advanced, locoregional (regional lymph node involvement) and metastatic disease were 16.6%, 66.6% and 16.6%, respectively. At data cut off (median number of doses of NIVO: 15), 15 pts (62.5%) remain on treatment and 6 pts have progressed and/or died. Three pts completed 12 months of treatment and entered surveillance. Among 22 pts evaluable for response (n = 2 have not reached 12w of treatment), the bORR was 54.5% (12/22), and disease control (stable disease or objective response) was achieved in 77% (17/22). Median duration of response, PFS and OS have not been reached. Grade ≥3 treatment-related adverse events occurred in 21% of the pts, and 1 patient discontinued NIVO due to toxicities. Conclusions: NIVO resulted in robust antitumor activity and good tolerability in systemic treatment-naïve pts with AcSCC. There were no new safety signals, despite the inclusion of individuals at advanced ages. These data provide further evidence to support the use of ICP as the standard treatment option for pts with AcSCC. Clinical trial information: NCT03834233.
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Affiliation(s)
| | | | | | | | - Mirella Nardo
- Instituto do Câncer do Estado de São Paulo, São Paulo, Brazil
| | | | | | - Ingrid Barbosa
- Instituto do Cancer do Estado de São Paulo, São Paulo, Brazil
| | - Herminia Ricci
- Instiuto do Cancer do Estado de São Paulo, São Paulo, Brazil
| | | | | | - Guilherme Urano Machado
- Oncology Department, Hospital das Clínicas da Faculdade de Medicina de RIbeirao Preto USP, Ribeirao Preto, Brazil
| | | | | | - Fabio A. Franke
- Hospital de Caridade de Ijuí Avenida David José Martins, Ijuí, Brazil
| | - Olavo Feher
- Instituto do Câncer do Estado de São Paulo, São Paulo, Brazil
| | - Gilberto Castro
- Instituto do Cancer do Estado de São Paulo, São Paulo, Brazil
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20
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Lôbo MDM, Calsavara VF, Ricci BV, Lopes Pinto CA, Bertolli E, Duprat Neto JP. Response rates of cutaneous melanoma metastases to diphencyprone: A meta-analysis. J Am Acad Dermatol 2020; 83:1812-1813. [PMID: 32289400 DOI: 10.1016/j.jaad.2020.04.023] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2020] [Revised: 03/31/2020] [Accepted: 04/02/2020] [Indexed: 10/24/2022]
Affiliation(s)
- Matheus de Melo Lôbo
- Surgical Oncology Residence Program, A.C. Camargo Cancer Center, São Paulo, SP, Brazil
| | | | - Bruno Vita Ricci
- Surgical Oncology Residence Program, A.C. Camargo Cancer Center, São Paulo, SP, Brazil
| | | | - Eduardo Bertolli
- Skin Cancer Department, A.C. Camargo Cancer Center, São Paulo, SP, Brazil.
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21
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Calsavara VF, Milani EA, Bertolli E, Tomazella V. Long-term frailty modeling using a non-proportional hazards model: Application with a melanoma dataset. Stat Methods Med Res 2019; 29:2100-2118. [DOI: 10.1177/0962280219883905] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
The semiparametric Cox regression model is often fitted in the modeling of survival data. One of its main advantages is the ease of interpretation, as long as the hazards rates for two individuals do not vary over time. In practice the proportionality assumption of the hazards may not be true in some situations. In addition, in several survival data is common a proportion of units not susceptible to the event of interest, even if, accompanied by a sufficiently large time, which is so-called immune, “cured,” or not susceptible to the event of interest. In this context, several cure rate models are available to deal with in the long term. Here, we consider the generalized time-dependent logistic (GTDL) model with a power variance function (PVF) frailty term introduced in the hazard function to control for unobservable heterogeneity in patient populations. It allows for non-proportional hazards, as well as survival data with long-term survivors. Parameter estimation was performed using the maximum likelihood method, and Monte Carlo simulation was conducted to evaluate the performance of the models. Its practice relevance is illustrated in a real medical dataset from a population-based study of incident cases of melanoma diagnosed in the state of São Paulo, Brazil.
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Affiliation(s)
- Vinicius F Calsavara
- Department of Epidemiology and Statistics, A.C.Camargo Cancer Center, São Paulo, Brazil
| | - Eder A Milani
- Institute of Mathematics and Statistics, Federal University of Goiás, Goiânia, Brazil
| | - Eduardo Bertolli
- Skin Cancer Department, A.C.Camargo Cancer Center, São Paulo, Brazil
| | - Vera Tomazella
- Department of Statistics, Federal University of São Carlos, São Carlos, Brazil
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22
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van Veenendaal LM, Bertolli E, Korse CM, Klop WMC, Tesselaar ME, Van Akkooi ACJ. The clinical utility of neuron-specific enolase serum levels as a biomarker for Merkel cell carcinoma. J Clin Oncol 2019. [DOI: 10.1200/jco.2019.37.15_suppl.9570] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
9570 Background: To date no adequate biomarker for Merkel Cell carcinoma (MCC) has been identified. The introduction of immunotherapy (IT) for metastatic MCC increases the need for a biomarker. Serum Neuron-specific enolase (NSE) has already been tested and is commonly used as a biomarker for several small cell malignancies. However, the role of NSE in MCC is still unclear. Aim: To investigate the role of NSE as a biomarker in MCC. Methods: A prospective cohort of MCC patients treated from 2016 to July 2018 was analyzed. Kaplan Meier curves with log rank test, Cox regression and mixed models were used to analyze NSE. A separate evaluation was performed for patients treated with IT. Results: A total of 78 patients (42 males, median age 71 years, stage I&II, III and IV MCC in 37(47%), 39(50%) and 2(3%) patients at time of diagnosis with 474 NSE levels (median 15 ; IQR 12,6-22 ng/ml were included. Baseline NSE (n=36) had no influence on survival or progression. During follow-up (FU) NSE levels correlated with tumorload (p=0,01) with increase of 15 ng/ml per class (no tumorload, localized MCC, nodal and distant metastases, respectively). NSE level during FU was able to detect progression (AUC 0,89). Several cut off values were evaluated. A NSE of 18,2 ng/ml was considered the most optimal level for clinical use (sensitivity 91%, specificity 78%, PPV 48%, NPV 98% to detect progression). During IT (n=16; 195 NSE values) all complete responders (n=7) had a normalized NSE (<18,2 ng/ml), all partial responders (n=3) had a decreasing NSE. In non-responders (n=6) all NSE levels remained elevated, one patient responded after switching to different IT with normalizing NSE values. Conclusions: NSE seems to be a valuable biomarker in MCC. NSE correlates with tumorload; is able to rule out progression and distinguishes responders from non-responders during IT.
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Affiliation(s)
| | | | | | - W. Martin. C. Klop
- Netherlands Cancer Institute, Antoni van Leeuwenhoek Hospital, Amsterdam, Netherlands
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Bertolli E, Franke V, Calsavara VF, de Macedo MP, Pinto CAL, van Houdt WJ, Wouters MWJM, Duprat Neto JP, van Akkooi ACJ. Validation of a Nomogram for Non-sentinel Node Positivity in Melanoma Patients, and Its Clinical Implications: A Brazilian–Dutch Study. Ann Surg Oncol 2018; 26:395-405. [DOI: 10.1245/s10434-018-7038-9] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2018] [Indexed: 12/14/2022]
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Bertolli E, de Macedo MP, Calsavara VF, Pinto CAL, Duprat Neto JP. A nomogram to identify high-risk melanoma patients with a negative sentinel lymph node biopsy. J Am Acad Dermatol 2018; 80:722-726. [PMID: 30395920 DOI: 10.1016/j.jaad.2018.10.060] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2018] [Revised: 10/16/2018] [Accepted: 10/28/2018] [Indexed: 12/23/2022]
Abstract
BACKGROUND Melanoma patients with negative nodes after sentinel lymph node biopsy are a heterogeneous group. Current guidelines fail to adequately stratify surveillance and treatment for this group. Also, there is scarce data on adjuvant treatments for these patients. OBJECTIVE To create a nomogram including clinical and pathologic characteristics capable of evaluating the risk for recurrence of primary melanoma patients with negative sentinel lymph node biopsies (SLNBs). METHODS We used a retrospective cohort of patients who underwent SLNB during 2000-2015 at a single institution. RESULTS Our cohort comprised 1213 patients. Among these patients, 967 (79.7%) had a negative SLNB, and mean follow-up was 59.67 months. There were 133 recurrences (13.8%); 45 (33.8%) presented with nodal recurrence, and 35 (26.3%) recurred where a SLNB was performed. Breslow thickness, ulceration, and microsatellitosis were found to be predictive of risk for recurrence at 1, 2, 5, and 10 years. LIMITATION Single center analysis. CONCLUSION We created a predictive nomogram for melanoma patients with negative SLNBs. This nomogram is easy to use and identifies high-risk patients who should have more strict surveillance and be considered for adjuvant treatment.
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Affiliation(s)
- Eduardo Bertolli
- Skin Cancer Department, AC Camargo Cancer Center, São Paulo, Brazil.
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Brandão PHDM, Bertolli E, Doria-Filho E, Santos Filho IDAO, de Macedo MP, Pinto CAL, Duprat Neto JP. In transit sentinel node drainage as a prognostic factor for patients with cutaneous melanoma. J Surg Oncol 2018; 117:864-867. [PMID: 29484669 DOI: 10.1002/jso.25023] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2017] [Accepted: 01/26/2018] [Indexed: 12/24/2022]
Abstract
BACKGROUND Minor basin or in transit node drainage can be found in patients with cutaneous melanoma who undergo sentinel node biopsy. Its clinical impact is still unclear. Our objective is to evaluate clinical outcomes in patients who presented with in transit sentinel node (ITN) drainage. MATERIAL AND METHODS Retrospective analysis of patients who underwent sentinel node biopsy (SNB) in a single Brazilian institution between 2000 and 2015. RESULTS Our cohort comprised 1223 SNB. There were 64 patients (5.2%) with ITN. Melanoma of the limbs (OR 10.61, P < 0.0001) and acral subtype (OR 3.49, P < 0.0001) were associated with ITN drainage. Among these 64 patients, 14 (21.9%) had a positive SNB. The ITN was positive for metastases in five patients, four in a popliteal basin and one on the trunk. Regarding completion node dissection (CND), two patients had positive non-sentinel nodes (NSN), both in major basins. In patients who developed recurrence, time to recurrence was shorter (mean time 18 vs 31.4 months, P = 0.001) and time to death was shorter (mean time 31.6 vs 40 months, P = 0.039) in those who had ITN drainage. CONCLUSION ITN drainage was associated with earlier recurrences and deaths from melanoma.
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Affiliation(s)
- Paulo H D M Brandão
- Surgical Oncology Medical Residence Program, AC Camargo Cancer Center, São Paulo, Brazil
| | - Eduardo Bertolli
- Skin Cancer Department, AC Camargo Cancer Center, São Paulo, Brazil
| | - Eduardo Doria-Filho
- Surgical Oncology Medical Residence Program, AC Camargo Cancer Center, São Paulo, Brazil
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Molina AS, Duprat Neto JP, Bertolli E, da Cunha IW, Fregnani JHTG, Figueiredo PHM, Soares FA, Macedo MP, Pinto Lopes CA, de Abranches Oliveira Santos Filho ID. Relapse in dermatofibrosarcoma protuberans: A histological and molecular analysis. J Surg Oncol 2018; 117:845-850. [PMID: 29509956 DOI: 10.1002/jso.25039] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2018] [Accepted: 02/09/2018] [Indexed: 01/17/2023]
Abstract
BACKGROUND Dermatofibrosarcoma protuberans (DFSP) is a rare low grade tumor with a locally aggressive behavior and low metastatic potential. OBJECTIVES To evaluate the factors that are associated with relapse in DFSP. Methods Retrospective analysis of medical records from 61 patients with dermatofibrosarcoma. Fluorescence in situ hybridization was used to detect translocations. RESULTS Of 61 patients, 6 experienced a relapse. No patient with resection margins greater than 3 cm had a recurrence. One relapse was observed in a patient treated with at least 2 cm margins and 4 relapses occurred in 16 patients whose margins were below 2 cm (P = 0.018). The frequency of translocations was 77.8%. The recurrence rate was lower in patients with translocation, but this difference was not significant. Immunohistochemical markers did not correlate with recurrence rates, but greater FasL expression was associated with recurrence in patients with margins smaller than 3 cm. CONCLUSIONS Surgical margins smaller than than 2 cm are related to higher recurrences in dermatofibrosarcomas. In this analysis a 2 cm margin was acceptable for treatment. Between all the immunohistochemical markers analyzed, only FasL was associated with a higher recurrence rate in patients with margins smaller than 3 cm.
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Affiliation(s)
- André S Molina
- Skin Cancer Department, AC Camargo Cancer Hospital, São Paulo, Brazil
| | | | - Eduardo Bertolli
- Skin Cancer Department, AC Camargo Cancer Hospital, São Paulo, Brazil
| | | | - José H T G Fregnani
- Research and Teaching Institute of Barretos Cancer Hospital, Barretos, Brazil
| | | | - Fernando A Soares
- Department of Pathology, AC Camargo Cancer Hospital, São Paulo, Brazil
| | - Mariana P Macedo
- Department of Pathology, AC Camargo Cancer Hospital, São Paulo, Brazil
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Gibbons IL, Sonagli M, Bertolli E, de Macedo MP, Pinto CAL, Duprat Neto JP. Diphencyprone as a therapeutic option in cutaneous metastasis of melanoma. A single-institution experience. An Bras Dermatol 2018; 93:299-301. [PMID: 29723355 PMCID: PMC5916415 DOI: 10.1590/abd1806-4841.20187162] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2017] [Accepted: 07/19/2017] [Indexed: 11/22/2022] Open
Abstract
Diphencyprone has been reported as a local immunotherapy for cutaneous melanoma metastases. We aim to report cases of melanoma patients treated with diphencyprone in a single Brazilian institution and highlight their outcomes. Since 2012, we have treated 16 melanoma patients with cutaneous metastases with topical diphencyprone. To date, we have had 37.5% of complete response, 25% of partial responses, and 31.25% patients without any response. Treatment was well tolerated and local toxicity was easily controlled. We believe topical diphencyprone is a feasible treatment that can be another option for treating melanoma patients, especially in cases of in-transit or extensive disease.
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Affiliation(s)
| | - Marina Sonagli
- Oncology Residency Training Program - AC Camargo Cancer Center -
São Paulo (SP), Brazil
| | - Eduardo Bertolli
- Skin Cancer Center - AC Camargo Cancer Center - São Paulo
(SP), Brazil
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Bertolli E, Bevilacqua JLB, Molina AS, de Macedo MP, Pinto CAL, Duprat Neto JP. Popliteal sentinel lymph node involvement in melanoma patients. J Surg Oncol 2015; 112:179-82. [PMID: 26227662 DOI: 10.1002/jso.23978] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2014] [Accepted: 07/04/2015] [Indexed: 11/11/2022]
Abstract
BACKGROUND Sentinel lymph nodes (SLN) in popliteal basins are rare, and there is controversy in literature regarding their origin, management, and outcomes. OBJECTIVES To correlate clinical and pathological features of popliteal basin drainage and analyze the impact of popliteal lymph node drainage on survival. MATERIALS AND METHODS Retrospective analysis of SLN biopsies performed at a single institution between 2000 and 2010. RESULTS SLN biopsies were performed in 254 patients with melanoma in lower limbs, 247 of which were evaluated. In this group, there were 59 patients (24%) with a positive SLN. Twenty-seven cases (11%) presented with popliteal drainage, one of which lacked concurrent groin drainage. Among these 27 patients, three (11%) had popliteal metastasis, one of which had exclusive involvement of this basin. Popliteal drainage was associated with worse 5-year disease-free survival (DFS) (P = 0.028) but not 5-year overall survival (OS) (P = 0.219) in univariate analysis. In multivariate analysis, Breslow thickness, mitotic index, and positive SLN were prognostic factors for DFS. Only mitotic index correlated significantly with OS (P = 0.044). CONCLUSIONS Popliteal drainage seems to be associated with worse prognostic features of the primary tumor.
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Affiliation(s)
- Eduardo Bertolli
- Skin Cancer Department, AC Camargo Cancer Center, São Paulo/SP, Brazil
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Bertolli E, Campagnari M, Molina AS, Macedo MP, Pinto CAL, Cunha IW, Duprat Neto JP. Artificial dermis (Matriderm®) followed by skin graft as an option in dermatofibrosarcoma protuberans with complete circumferential and peripheral deep margin assessment. Int Wound J 2013; 12:545-7. [PMID: 24102765 DOI: 10.1111/iwj.12157] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2013] [Revised: 08/01/2013] [Accepted: 08/02/2013] [Indexed: 12/01/2022] Open
Abstract
Dermatofibrosarcoma protuberans (DFSP) is a locally invasive neoplasia with a pattern of infiltrative growth that leads to extended resections. To avoid unnecessary resections and spare tissues, its treatment requires an adequate assessment of the margins. We present a case where artificial dermis (Matriderm®) was used followed by skin graft for reconstruction. We present a 50-year-old woman with a DFSP in the occipital region. She was referred to us after a first surgery with positive margins. A wide local excision with a 2-cm margin was performed and periosteal tissue was also removed, which led to exposure of the skull. Matriderm was placed on the bone surface and dressings were changed every other day. Meanwhile, margins were evaluated by the complete circumferential and peripheral deep margin assessment (CCPDMA) and were positive for DFSP in the superior margin. After 4 weeks the area was completely covered by granulation tissue and a new resection followed by reconstruction with a skin graft was performed. With regard to the difficulties in the margin assessment in DFSP, we present artificial dermis (Matriderm) as an option for reconstructive surgery in these patients, especially when a skin graft cannot be performed as a first option.
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Affiliation(s)
| | | | - André S Molina
- Skin Cancer Department, Hospital AC Camargo, São Paulo, Brazil
| | | | | | - Isabela W Cunha
- Pathology Department, Hospital AC Camargo, São Paulo, Brazil
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Duprat Neto JP, Oliveira F, Bertolli E, Molina AS, Nishinari K, Facure L, Fregnani JH. Isolated limb perfusion with hyperthermia and chemotherapy: predictive factors for regional toxicity. Clinics (Sao Paulo) 2012; 67:237-41. [PMID: 22473404 PMCID: PMC3297032 DOI: 10.6061/clinics/2012(03)06] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/03/2011] [Accepted: 11/23/2011] [Indexed: 11/18/2022] Open
Abstract
OBJECTIVE Isolated limb perfusion combined with melphalan is an accepted treatment for obtaining locoregional control in advanced melanoma of the extremities and other malignant neoplasias restricted to the limb. This study aims to examine the factors associated with toxicity caused by the regional method. We considered the technical aspects of severe complications associated with the procedure in an attempt to diminish the patient morbidity that occurs during the learning curve. METHODS We conducted a retrospective analysis of the records of patients who underwent perfusion at the AC Camargo Hospital in São Paulo, Brazil between January 2000 and January 2009. The Wieberdink scale was applied to classify local toxicity and its relation to clinical and laboratory variables. RESULTS Fifty-eight perfusions were performed in 55 patients. Most patients (86.2%) presented a toxicity level between I and III. Grade V toxicity was seen in five cases (8.6%), four of which occurred in the first 2 years. Creatine phosphokinase, an important predictive factor for toxicity, had an average value of 231.8 for toxicity grades I-III and 1286.2 for toxicity grades IV-V (p = 0.001). There was a relationship between the melphalan dose and toxicity, which was 77 mg (25 to 130 mg) for toxicity grades I-II and 93.5 mg (45 to 120 mg) for toxicity grades IV-V (p = 0.0204). CONCLUSION It is possible to prevent the toxicity associated with melphalan by adjusting the dose according to the patient's body weight (especially for women and obese patients) and the creatine phosphokinase values in the postoperative period.
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