Utility of 3-year torso computed tomography and head imaging in asymptomatic patients with high-risk melanoma

Abstract

Objective There is no general consensus regarding the optimal follow-up strategy for patients with melanoma. We sought to determine the utility and cost effectiveness of radiologic restaging of patients with stage IIB-IIIC melanoma at the 3-year follow-up time point. Methods A retrospective review of 210 patients diagnosed with stage IIB–IIIC melanoma seen in the Cutaneous Oncology Program at Beth Israel Deaconess Medical Center (BIDMC) between January, 2001 and July, 2006 was conducted. 52 patients were asymptomatic and continuously disease free and underwent re-staging head CT/MRI and torso CT scans three years after completion of local-regional therapy or initiation of adjuvant treatment. True positive, false positive and normal scans were identified and the cost per diagnosis calculated. Results Fifty-five percent of patients followed at BIDMC recurred; 88% before 3 years (median time to recurrence 12 months, 95% CI: 10–16 months). The majority (69%) recurred with disease symptoms. Twenty five head CT scans, 27 head MRIs, and 52 torso CTs were performed. One false positive head CT and 5 abnormal torso CT scans (3 false positive, 2 true positive) were identified. The total cost per diagnosis was $312,990. Conclusions Extensive 3-year re-staging imaging appears to be of limited value for symptomatic and continuously disease free patients with stage IIB–IIIC melanoma. Furthermore, given the low risk of recurrence beyond 3 years, it is likely that subsequent routine imaging would have similarly low utility.

High frequency of brain metastases after adjuvant therapy for high‐risk melanoma

“…The historical median survival of patients treated with whole-brain radiotherapy was only 3-4 months [24][25][26]. This statistic discouraged most attempts at early detection [21,22]. Fortunately, there have been substantial improvements in ablation of brain metastases and in systemic therapy options for metastatic melanoma that may be capable of influencing survival in patients with CNS relapse [23,27,28].…”

“…A total of 115 (55%) relapsed either systemically or in the CNS, 101 relapsed prior to 3 years. The median time to recurrence was 12 months (95% confidence interval: 10–16 months) . Planned radiographic restaging was performed in 52 patients who reached the 3‐year time point without apparent recurrence was performed.…”

Malignant Melanoma S3‐Guideline “Diagnosis, Therapy and Follow‐up of Melanoma”

“…Predictive parameters for a response, particularly for CR, are tumor stage, number of in-transit metastases (< 10) and maximum tumor diameter < 4 cm [438,440]. For large-volume melanoma metastases (bulky disease), there is evidence that ILP with TNF may be more efficacious than ILP with melphalan alone [441,442].…”

S3‐Leitlinie Diagnostik, Therapie und Nachsorge des Melanoms – Update 2015/2016, Kurzversion 2.0

“…Empfehlung EG LoE Quellen 3.138. (2013)Eine Schnittbildgebung sollte routinemäßig in der Nachsorge von Melanompatienten ab Stadium IIC erfolgen.B1aDe‐novo‐Recherche: …”