The Current Treatment Trends and Survival Patterns in Melanoma Patients with Positive Sentinel Lymph Node Biopsy (SLNB): A Multicenter Nationwide Study.

BACKGROUND: In melanoma treatment, an approach following positive sentinel lymph node biopsy (SLNB) has been recently deescalated from completion lymph node dissection (CLND) to active surveillance based on phase III trials data. In this study, we aim to evaluate treatment strategies in SLNB-positive melanoma patients in real-world practice. METHODS: Five-hundred-fifty-seven melanoma SLNB-positive patients from seven comprehensive cancer centers treated between 2017 and 2021 were included. Kaplan-Meier methods and the Cox Proportional-Hazards Model were used for analysis. RESULTS: The median follow-up was 25 months. Between 2017 and 2021, the percentage of patients undergoing CLND decreased (88-41%), while the use of adjuvant treatment increased (11-51%). The 3-year OS and RFS rates were 77.9% and 59.6%, respectively. Adjuvant therapy prolonged RFS (HR:0.69, p = 0.036)), but CLND did not (HR:1.22, p = 0.272). There were no statistically significant differences in OS for either adjuvant systemic treatment or CLND. Lower progression risk was also found, and time-dependent hazard ratios estimation in patients treated with systemic adjuvant therapy was confirmed (HR:0.20, p = 0.002 for BRAF inhibitors and HR:0.50, p = 0.015 for anti-PD-1 inhibitors). CONCLUSIONS: Treatment of SLNB-positive melanoma patients is constantly evolving, and the role of surgery is currently rather limited. Whether CLND has been performed or not, in a group of SLNB-positive patients, adjuvant systemic treatment should be offered to all eligible patients.

Survival of patients with stage IIIC and IIID melanomas with nodal metastases in the light of new therapies.

Introduction: Within stage III melanoma prognosis and outcomes significantly vary. Advances in systemic therapy improved prognosis in metastatic melanoma. Adjuvant therapy in stage III significantly lowered relapses, although the effect on survival is less evident. Analysis of treatment results in stage IIIC and IIID before introduction of the modern adjuvant therapy, but after introduction of the effective systemic therapy in metastatic relapse, is needed. Aim: To analyse the clinical outcomes in patients with stage IIIC and IIID melanoma before the introduction of the novel adjuvant therapy. Material and methods: Consecutive stage IIIC and IIID melanoma patients treated in 2015-2018 in 4 reference centres in Poland were enrolled in the analysis of RFS and OS (in-transit metastases excluded). Median follow-up was 26.6 months (1.7-67.2). Results: There were 224 stage IIIC and 49 stage IIID patients. Recurrence was observed in 170 (62.2%); 102 (45.5%) deaths in stage IIIC and 28 (57.1%) in stage IIID were reported. RFS and OS were better in stage IIIC compared to stage IIID. RFS and OS in the IIIC group were 19.7 and 36.2 months, respectively, and in IIID - 8.9 and 27.8 months, respectively. Conclusions: The survival of patients with high-risk melanomas has improved in recent years, however, it is still unsatisfactory. The major changes in melanoma management related to the introduction of the adjuvant therapy require further careful observation.

Analysis of disease free survival in cutaneous melanoma patients subject to sentinel lymph node biopsy.

<b>Introduction:</b> Cutaneous melanoma is estimated for 2% of malignant neoplasms occurring in humans. It is characterized by a high level of malignancy and low sensitivity to cytostatic drugs. The incidence of cutaneous melanoma is increasing in Poland. The lymphatic system is the most common route of dissemination of this neoplasm. The appearance of a sentinel node biopsy technique has made it possible to identify patients with a regionally advanced disease. It is a minimally invasive method with a small percentage of complications. <br><b>Aim: </b>Analysis of disease free survival (DFS) in cutaneous melanoma patients with sentinel lymph node biopsy. <br><b>Material and methods:</b> The analysis included 222 patients with cutaneous melanoma treated in the Department of Oncological Surgery in 2010-2015, who underwent a sentinel node biopsy. The study group consisted of 136 women and 86 men, the average age of patients was 59 years. Patients were qualified for sentinel node biopsy based on clinical evaluation and ultrasound of regional lymph nodes. The average follow-up was 25.1 months. About 2 hours before surgery, patients received a radioisotope, then lymphoscintigraphy SPECT was performed. Additionally, they were administered the Patent Blue dye in the operating room. <br><b>Results:</b> The sentinel node was identified in 217 patients (98%), and the average sentinel nodes were 2.25. Twenty-seven patients (12%) had a metastasis in sentinel nodes. In this group, the duration of symptom free survival was significantly shorter. Sentinel node status and age of the patient were independent factors affecting the prognosis of disease free survival. <br><b>Conclusions:</b> Sentinel node biopsy is a precise method to identify patients with cutaneous melanoma who have metastasis to regional lymph nodes, as well as the most important prognostic factor.

[Modern principles of surgical treatment of breast cancer]. / Wspólczesne zasady chirurgicznego leczenia chorych na raka piersi.

A rapid increase in the incidence of breast cancer (BC) has been observed since the mid-20th century in Poland. It is accompanied by a slower but steady increase in mortality. BC is the most common malignancy in women in Poland and in the world. In 2012, the reported 17,000 new cases of BC in Poland. The incidence of breast cancer increases, but significantly improves the prognosis of women in recent years. 5-year survival is currently closer to 80% in Poland. Improving the prognosis is associated with two factors: the earlier detection and more effective cancer treatment. Mammography screening increased the detection of cancer in the early stages. Thanks to the use of all methods of cancer treatment (surgery, radiotherapy, chemotherapy, hormonal therapy) resulted in a significant treatment effect. BC has become a chronic disease.

[Solitary fibrous tumor of the pleura (SFTP) hidden in the pleural effusion]. / Umiejscowiony wlóknisty guz oplucnej (SFTP) ukryty w wysieku oplucnowym.

UNLABELLED: The patient with a non-malignant type of solitary fibrous tumor of the pleura (SFTP) has been presented as an example; this tumor manifested itself in long-lasting pleural effusion. The tumor, submerged in the liquid, with the diameter of 16 cm, was invisible in standard and computer X-rays of the chest. The tumor was found and removed during the thoracotomy. The patient has been alive for 9 years, without symptoms of the disease since the operation was performed. CONCLUSIONS: 1. The source of one-sided exudation can be a non-malignant SFTP. 2. Tumor submerged in the liquid can be invisible on standard and computer pictures of the chest.

[Metastases of the melanoma to the intestine]. / Przerzuty czerniaka do jelit.

The cases of 4 patients with primary skin melanoma, who underwent resection of the small intestine due to the intestinal metastases, are presented. Two patients died as a result of metastases after intestinal resection; the other two have been alive for a year and 10 years without any symptoms of the disease. The presence of the melanoma metastases to the intestine can be suspected in patients with anaemia caused by bleeding into the lumen of an intestine, ileus, rapid weight loss or noticeable tumor in the abdomen. The resection of intestine with metastases should be chosen as a safe method, which allows good palliation; it also offers the chance for a longer life.

[Early results of esophagectomy and total or proximal gastrectomy without perioperative administration of total parenteral nutrition]. / Wczesne powiklania i zgony po wycieciu przelyku oraz blizszym lub calkowitym wycieciu zoladka u chorych leczonych bez stosowania calkowitego zywienia pozajelitowego.

UNLABELLED: The aim of the study was to analyse complications after radical oesophagectomy or gastrectomy in cancer patients without administration of total parental nutrition (TPN). PATIENTS AND METHODS: 45 consecutive patients underwent oesophagectomy (8 patients), proximal subtotal gastrectomy (10 patients) and total gastrectomy (27 patients). Stapler sutures were used to create anastomoses between oesophagus and stomach or oesophagus and jejunum. None patient received TPN. In all patients antropometrical and biochemical characteristics were assessed. Preoperative risk factors and type of complications were estimated. Patients with surgical complications were compared with patients without surgical complications using anthropometric and biochemical values. RESULTS: Surgical complications occurred in 10(22%) patients. The most common complication was postoperative wound infection (6 patients). Anastomotic dehiscence occurred in 4 patients and resulted in 2 deaths. Complications and deaths were observed more frequently in severely malnourished patients (BMI < 18). CONCLUSIONS: There is no justification for routine perioperative use of TPN in patients without severe malnutrition undergoing oesophageal or gastric surgery for cancer.