Thermal Ablation Can Treat Some Focal Melanoma Metastases

Dr. Mariah White

Mariah L. White Interview with:
Mariah L. White, MD

Department of Radiology
Mayo Clinic
Rochester, MN 55905

Medical Research: What is the background for this study?

Dr. White: Stage IV (metastatic) melanoma carries a poor prognosis with median survival of 6 to 10 months, claiming over 9000 lives per year in the United States. There is evidence that aggressive focal treatment in patients with oligometastatic disease with complete eradication of all clinical disease can result in durable remissions and potentially improve overall survival. Oligometastatic disease is typically defined as metastatic disease limited to 5 or fewer lesions. Thermal ablation is an alternative local management strategy to resection of limited sites of distant spread.  Similar to surgical management of oligometastatic disease it can be used in conjunction with systemic medical therapy or as an alternative in those patients where SMT is not well tolerated or unable to achieve complete remission.

Medical Research: What are the main findings?

Dr. White: In this study, we evaluated all patients who underwent image-guided local thermal ablation of metastatic melanoma over an 11-year period at the Mayo Clinic Rochester. We limited our study to those patients with 5 or few melanoma metastases, that were amenable to complete ablation of all clinical disease at the time of treatment for our the analysis. This included 33 patients with primary ocular or non-ocular melanoma with a sum of 66 metastases treated in the lungs, liver, adrenals, bones or soft tissues.

Eleven (33%) patients were on systemic medical therapy at the time of the procedure. The median survival time was 3.8 years with a 4-year estimated survival of 44.1%. Local recurrence at the ablation site developed in 15.1% of patients and 13.6% of tumors. Median progression-free survival time was 4.4 months with estimated 1-year progression-free survival of 30.3%.  Subgroup analysis identified 11 patients with primary ocular melanoma and 22 with non-ocular melanoma with median survival of 3.9 years and 3.8 years, respectively.  There were no major complications and no deaths within 30 days post procedure.

Large prospective and retrospective studies, both single and multicenter, have demonstrated patients who undergo complete surgical excision of their limited metastases have predicted median overall survival of 15.8-36.7 months, compared to our 45.2 months. These patients also demonstrate a 5-year overall survival rate ranging from 20.5-33%, compared to our 30%. The treatment discussed in this paper of complete percutaneous thermal ablation of metastases aims to achieve similar cytoreductive effects as surgery.

Medical Research: What should clinicians and patients take away from your report?

Dr. White: The take away message is that selective use of image-guided thermal ablation of oligometastatic melanoma may provide results similar to surgical resection in terms of technical effectiveness and oncologic outcomes with minimal risk. As this relates to clinical practice, thermal ablation of such metastatic disease may be considered an alternative to surgery in select patients. For patients, these findings support thermal ablation as a potential minimally invasive therapeutic alternative to surgery in those with 5 or fewer melanoma metastases.

Medical Research: What recommendations do you have for future research as a result of this study?

Dr. White: The next step for this line of research would be further prospective studies comparing the efficacy of ablation techniques with surgery in this select population to validate our findings.


Recurrence and Survival Outcomes After Percutaneous Thermal Ablation of Oligometastatic Melanoma

Mariah L. White, Thomas D. Atwell, A. Nicholas Kurup, Grant D. Schmit, Rickey E. Carter, Jennifer R. Geske, Lisa A. Kottschade, Jose S. Pulido, Matthew S. Block, James W. Jakub, Matthew R. Callstrom, Svetomir N. Markovic

Publication stage: In Press Corrected Proof
Published online: January 28 2016

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Mariah L. White, MD (2016). Thermal Ablation Can Treat Some Focal Melanoma Metastases 

Last Updated on January 30, 2016 by Marie Benz MD FAAD