Tumor doubling times in metastatic malignant melanoma of the uvea Tumor progression before and after treatment

Eskelin, Sebastian; Pyrhönen, Seppo; Summanen, Paula; Hahka‐Kemppinen, Marjo; Kivelä, Tero

doi:10.1016/s0161-6420(00)00182-2

Cited by 360 publications

(235 citation statements)

References 33 publications

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“…8 Other investigators proposed that uveal melanomas metastasize during a time of growth that coincides with the time they become clinically visible. This would be in keeping with the work of Eskelin et al 19,20 and supports the second hypothesis of Zimmerman and McLean, 23 ie, that removal of the eye alters the immune system and thus allows existing micrometastases to grow unchallenged.…”

Section: Natural History and Metastasissupporting

confidence: 88%

“…6,10 At this rate of growth, there is ample time to initiate treatment. An alternate model published by Eskelin et al 19 estimated that micrometastases could develop as early as 5 years prior to the treatment of the primary tumor, which presumably occurs when suspicious characteristics first appear. At this estimated time of micrometastasis, the primary tumor size would be theoretically only 7 mm 3 , or approximately 3 mm in diameter and 1.5 mm in height at the time of metastasis.…”

Section: Natural History and Metastasismentioning

confidence: 99%

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Choroidal Melanoma: Natural History and Management Options

Bell

Wilson

2004

Cancer Control

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Section: Natural History and Metastasissupporting

confidence: 88%

Section: Natural History and Metastasismentioning

confidence: 99%

Choroidal Melanoma: Natural History and Management Options

Bell

Wilson

2004

Cancer Control

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“…This result concurs with and complements limited studies performed in the field. Eskelin et al 22 and Singh 23 estimated that the time of micrometastasis in UM is 2.9 years earlier than the diagnosis of the primary tumour, indicating that dissemination has occurred before conservative treatment of the primary tumour.…”

Section: Discussionmentioning

confidence: 99%

Identification of circulating malignant cells and its correlation with prognostic factors and treatment in uveal melanoma. A prospective longitudinal study

Callejo

Antecka

Blanco

et al. 2006

Eye

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Purpose Most uveal melanoma patients (UMP) do not show evidence of metastases upon diagnosis. However, despite local tumour control, B50% of them will develop metastases. These findings suggest that malignant cells may have already disseminated by the time of initial diagnosis. The purpose of the study was to detect circulating malignant cells (CMCs) in UMP and to correlate them with prognostic factors and therapy. Methods Nested reverse transcriptasepolymerase chain reaction (RT-PCR) was used to detect CMCs. In each UMP, blood was collected every 3 months. In each visit, 20 RT-PCR tests were performed. The date of diagnosis, largest tumour dimension, type, and date of treatment were obtained. Results A total of 30 UMP were enrolled. Five patients were enrolled at the time of diagnosis and 25 patients between 1 and 17 years following diagnosis. No UMP showed clinical evidence of metastasis. A total of 136 visits were registered, 1360 samples collected, and 2720 RT-PCRs performed. CMCs were identified in 29 patients in 119 visits (87.5%). However, in each visit, a low number of positive tests were recorded. CMCs were found in newly diagnosed, irradiated, enucleated, and observed patients regardless of tumour size and time period following treatment. Conclusions Uveal melanoma (UM) is not a localized ocular disease. CMCs were recorded at initial diagnosis confirming the early metastatic nature of UM. CMCs were present following treatment, including enucleation, demonstrating that CMCs are capable of disseminating and surviving, possibly as micrometastasis, which would contribute to the pool of CMCs at a later stage. Systemic therapy should be evaluated.

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“…39 Studies based on tumor doubling times suggest that uveal melanomas destined to metastasize already have spawned clinically unapparent distant micrometases before the patient becomes symptomatic and consults an ophthalmologist. 40 Hence, it is probable that the ocular oncologist merely achieves local control in most cases, and has little or no effect on systemic outcome. Furthermore, there currently is no effective treatment for metastatic uveal melanoma; 80% of affected patients succumb to their metastatic tumor within 1 year.…”

mentioning

confidence: 99%