An Overview of Liver Directed Locoregional Therapies
An overview of all liver-directed locoregional therapies, including surgical resection for melanoma liver metastases (MLMs), is provided. MLM patients are divided by their primary melanoma location; cutaneous, uvea (eye), and mucosal melanoma. If patients with isolated cutaneous MLMs are considered for surgical resection, treatment with systemic therapy should be part of the treatment course. For uveal MLMs, complete surgical or ablative treatment of all MLMs suggests superior results compared with other liver-directed or systemic therapies, based on current evidence, no recommendations for any liver-directed regional ther...
Source: Surgical Oncology Clinics of North America - November 19, 2020 Category: Surgery Authors: Diederik J. H öppener, Dirk J. Grünhagen, Alexander M.M. Eggermont, Astrid A.M. van der Veldt, Cornelis Verhoef Source Type: research

Surgical Management of Colorectal Cancer Liver Metastases
This article discusses considerations impacting our approach to patients with colorectal liver metastases and the role for various multimodal treatment options. (Source: Surgical Oncology Clinics of North America)
Source: Surgical Oncology Clinics of North America - November 19, 2020 Category: Surgery Authors: Chandrasekhar Padmanabhan, Daniel P. Nussbaum, Michael D ’Angelica Source Type: research

Surgical Management of Gynecologic Cancers
This article addresses the role of surgery in the management of gynecologic cancers with liver metastases. The authors review the short-term and long-term outcomes of aggressive resection through retrospective and randomized studies. Although the data supporting aggressive resection of liver metastasis are largely retrospective and case based, the randomized control data to address neoadjuvant versus chemotherapy have been widely criticized. Residual disease remains an important predictor for survival in ovarian cancer. If a patient cannot achieve near optimal cytoreduction, radical cytoreductive procedures, such as hepati...
Source: Surgical Oncology Clinics of North America - November 19, 2020 Category: Surgery Authors: Kiran H. Clair, Juliet Wolford, Jason A. Zell, Robert E. Bristow Source Type: research

Metastatic Liver Tumors: The Path to Disease-Free Survival
It has been a great honor to edit this issue of Surgical Oncology Clinics of North America addressing the role of resection for liver metastases. It is a topic that has dominated my clinical and academic career for nearly 2 decades, and it is therefore near and dear to my heart. While the role of surgery for metastatic colorectal cancer has been well validated, the role of hepatic resection for other malignancies is less well studied. The lack of data is mostly due to the rarity of patients presenting with a pattern of disease that would even be considered for surgery and the diffuse systemic nature of most metastatic canc...
Source: Surgical Oncology Clinics of North America - November 19, 2020 Category: Surgery Authors: Michael D'Angelica Tags: Preface Source Type: research

Management of Metastatic Liver Tumors
This issue of the Surgical Oncology Clinics of North America focuses on the Management of Metastatic Liver Tumors. Over the last several decades, as systemic and targeted agents have become more effective in treating and prolonging the life of patients with a wide range of malignancies, indications for treatment of metastatic disease have broadened. Perhaps this point is best illustrated among patients with colorectal liver metastasis. In particular, while 20 or 30 years ago colorectal liver metastasis size and number, as well as CEA level, “dictated” operability, surgeons now focus less on these morphologic an...
Source: Surgical Oncology Clinics of North America - November 19, 2020 Category: Surgery Authors: Timothy M. Pawlik Tags: Foreword Source Type: research

Management of Metastatic Liver Tumors
SURGICAL ONCOLOGY CLINICS OF NORTH AMERICA (Source: Surgical Oncology Clinics of North America)
Source: Surgical Oncology Clinics of North America - November 19, 2020 Category: Surgery Authors: Michael D ’Angelica Source Type: research

Copyright
ELSEVIER (Source: Surgical Oncology Clinics of North America)
Source: Surgical Oncology Clinics of North America - November 19, 2020 Category: Surgery Source Type: research

Contributors
TIMOTHY M. PAWLIK, MD, MPH, PhD, FACS, FRACS (Hon) (Source: Surgical Oncology Clinics of North America)
Source: Surgical Oncology Clinics of North America - November 19, 2020 Category: Surgery Source Type: research

Contents
Timothy M. Pawlik (Source: Surgical Oncology Clinics of North America)
Source: Surgical Oncology Clinics of North America - November 19, 2020 Category: Surgery Source Type: research

Forthcoming Issues
Pediatric Cancer (Source: Surgical Oncology Clinics of North America)
Source: Surgical Oncology Clinics of North America - November 19, 2020 Category: Surgery Source Type: research

Surgical Management of Genitourinary Cancer Liver Metastases
Genitourinary cancers are common. Liver metastases from genitourinary cancers are uncommon; isolated liver metastasis is rare. Liver resection in select patients with metastatic renal cell carcinoma can lead to prolonged survival. Patients with metachronous and low-burden disease are most likely to benefit. Chemotherapy is first-line treatment of metastatic germ cell tumors. Liver resection is dependent on germ cell lineage and initial response to chemotherapy. Prognosis with liver metastases from prostate cancer is poor; liver-only lesions are rare. Liver resection generally is not indicated. Cumulative experience with li...
Source: Surgical Oncology Clinics of North America - October 28, 2020 Category: Surgery Authors: Guillaume Martel, Kimberly A. Bertens, Christina Canil Source Type: research

Is There a Role for Locoregional Therapies for Non-colorectal Gastrointestinal Malignancies?
The liver is the most common site of metastases from solid gastrointestinal tract tumors. Over the past few decades, the role of locoregional therapies, resection and thermal ablation, for neuroendocrine and colorectal liver metastases has been widely studied. However, for liver metastases originating from other gastrointestinal organs, the role of locoregional treatment remains unclear. This review summarizes and discusses the available evidence regarding benefits, risks, and indications for locoregional therapies for non-colorectal and non-neuroendocrine gastrointestinal liver metastases, highlighting the importance of m...
Source: Surgical Oncology Clinics of North America - October 28, 2020 Category: Surgery Authors: Gilton Marques Fonseca, Maria Ignez Freitas Melro Braghiroli, Jaime Arthur Pirola Kruger, Fabricio Ferreira Coelho, Paulo Herman Source Type: research

Systemic Therapy Improvements Will Render Locoregional Treatments Obsolete for Patients with Cancer with Liver Metastases
Hepatic metastases are a major cause of morbidity and mortality for patients with cancer. Apart from curative resection, which offers patients the potential for long-term survival, an array of locoregional therapies, with limited evidence of improving survival, are used to treat them. The authors use examples from the realm of gastrointestinal cancer, largely focusing on the experience of patients with neuroendocrine cancer, hepatobiliary cancer, and colorectal cancer, to suggest that current systemic therapies offer, at minimum, similar survival outcomes for patients compared with these locoregional approaches. (Source: S...
Source: Surgical Oncology Clinics of North America - October 28, 2020 Category: Surgery Authors: Satya Das, Jordan Berlin Source Type: research

Surgical Management of Breast Cancer Liver Metastasis
This article reviews data related to hepatic resection and ablative therapies of BCLM, as well as long-term outcomes of women treated with these approaches. (Source: Surgical Oncology Clinics of North America)
Source: Surgical Oncology Clinics of North America - October 28, 2020 Category: Surgery Authors: Amir A. Rahnemai-Azar, Luke V. Selby, Maryam B. Lustberg, Timothy M. Pawlik Source Type: research

Debate
The benefit of resection of liver metastases depends on primary diseases. Neuroendocrine tumors are associated with favorable prognosis after resection of liver metastases. Gastric cancer has worse tumor biology, and resection of gastric liver metastases should be performed in selected patients. A multidisciplinary approach is well established for colorectal liver metastases (CLMs). Resection remains the only curative treatment of CLM. Chemotherapy and molecular-targeted therapy have improved survival in unresectable metastatic colorectal cancer. Understanding of the following two strategies, conversion therapy and two-sta...
Source: Surgical Oncology Clinics of North America - October 27, 2020 Category: Surgery Authors: Yoshikuni Kawaguchi, Mario De Bellis, Elena Panettieri, Gregor Duwe, Jean-Nicolas Vauthey Source Type: research

Surgical Management of Neuroendocrine Tumor Liver Metastases
Patients with neuroendocrine tumor liver metastases (NETLMs) may develop carcinoid syndrome, carcinoid heart disease, or other symptoms from overproduction of hormones. Hepatic resection and cytoreduction is the most direct treatment of NETLMs in eligible patients, and cytoreduction improves symptoms, may reduce the sequelae of carcinoid syndrome, and extends survival. Parenchymal-sparing procedures, such as ablation and enucleation, should be considered during cytoreduction to maximize treatment of multifocal tumors while preserving healthy liver tissue. For patients with large hepatic tumor burdens, high-grade disease, o...
Source: Surgical Oncology Clinics of North America - October 20, 2020 Category: Surgery Authors: Catherine G. Tran, Scott K. Sherman, Chandrikha Chandrasekharan, James R. Howe Source Type: research

Surgical Management of Sarcoma Metastatic to Liver
Sarcomas are rare mesenchymal tumors with a propensity for hematogenous metastasis. Gastrointestinal stromal tumor (GIST) is the most common histologic subtype and the most common source of hepatic metastases. In the case of metastatic GIST, neoadjuvant imatinib can be used as a selection tool for the judicious application of surgery, where treatment-responsive patients who undergo resection to prevent the development of treatment-resistant clones have associated 10-year actuarial survival of 40%. Further advances for many of the non-GIST sarcoma subtypes will depend on the development of improved systemic therapies and ev...
Source: Surgical Oncology Clinics of North America - October 20, 2020 Category: Surgery Authors: Brett L. Ecker, Robert G. Maki, Michael J. Cavnar, Ronald P. DeMatteo Source Type: research

Intraarterial Chemotherapy for Liver Metastases
This article summarizes the role of HAI chemotherapy in the treatment of liver metastatic CRC. (Source: Surgical Oncology Clinics of North America)
Source: Surgical Oncology Clinics of North America - October 20, 2020 Category: Surgery Authors: Louise C. Connell, Nancy E. Kemeny Source Type: research

External Beam Radiation Therapy for Liver Metastases
Stereotactic ablative radiotherapy (SABR) commonly is used for small liver metastases. Modern conformal radiotherapy techniques, including 3-dimensional conformal radiotherapy and intensity-modulated radiation therapy, enable the safe delivery of SABR to small liver volumes. For larger tumors, the safe delivery of SABR can be challenging due to a more limited volume of healthy normal liver parenchyma and the proximity of the tumor to radiosensitive organs, such as the stomach, duodenum, and large intestine. Controlling respiratory motion, the use of image guidance, and increasing the number of radiation fractions sometimes...
Source: Surgical Oncology Clinics of North America - October 20, 2020 Category: Surgery Authors: Paul B. Romesser, Brian P. Neal, Christopher H. Crane Source Type: research

Hepatic Perfusion for Diffuse Metastatic Cancer to the Liver
The management of patients with diffuse liver metastases remains a significant clinical challenge. In many cancer patients, metastatic disease may be isolated to the liver or the liver may be the dominant site of progressive metastatic cancer. In this setting, progression of disease in the liver generally is the most significant cause of morbidity and mortality. (Source: Surgical Oncology Clinics of North America)
Source: Surgical Oncology Clinics of North America - October 20, 2020 Category: Surgery Authors: H. Richard Alexander, Virginia Devi-Chou Source Type: research

Surgery for Locally Advanced and Oligometastatic Non –Small Cell Lung Cancer
Locally advanced non –small cell lung cancer is a heterogeneous group of tumors that require multidisciplinary treatment. Although there is much debate with regard to their management, a multimodal treatment strategy for carefully selected patients that includes surgery can extend survival compared with nonoperative d efinitive therapy. As the role of targeted therapies and immune checkpoint inhibitors for these tumors becomes better defined, practices will continue to evolve. (Source: Surgical Oncology Clinics of North America)
Source: Surgical Oncology Clinics of North America - September 1, 2020 Category: Surgery Authors: Jenalee N. Coster, Shawn S. Groth Source Type: research

Surgical Oncology Clinics of North America
Management of Metastatic Liver Tumors (Source: Surgical Oncology Clinics of North America)
Source: Surgical Oncology Clinics of North America - September 1, 2020 Category: Surgery Source Type: research

Copyright
ELSEVIER (Source: Surgical Oncology Clinics of North America)
Source: Surgical Oncology Clinics of North America - September 1, 2020 Category: Surgery Source Type: research

Contributors
TIMOTHY M. PAWLIK, MD, MPH, PhD, FACS, FRACS (Hon.) (Source: Surgical Oncology Clinics of North America)
Source: Surgical Oncology Clinics of North America - September 1, 2020 Category: Surgery Source Type: research

Contents
Timothy M. Pawlik (Source: Surgical Oncology Clinics of North America)
Source: Surgical Oncology Clinics of North America - September 1, 2020 Category: Surgery Source Type: research

Forthcoming Issues
Management of Metastatic Liver Tumors (Source: Surgical Oncology Clinics of North America)
Source: Surgical Oncology Clinics of North America - September 1, 2020 Category: Surgery Source Type: research

Current Indications for Pulmonary Metastasectomy
The lung is one of the most common sites of metastatic disease. Assessing patients for pulmonary metastasectomy includes ensuring they are suitable surgical candidates for single-lung ventilation and pulmonary resection. Complete resection of metastases and control of primary tumor and oligometastatic disease are key tenets for metastasectomy. Negative prognostic factors include short disease-free interval, presence of lymphadenopathy, and multiple lesions. Primary tumors are associated with excellent outcomes. With modern high-resolution scans, minimally invasive approaches to metastasectomy are preferred. Consideration o...
Source: Surgical Oncology Clinics of North America - August 11, 2020 Category: Surgery Authors: Monisha Sudarshan, Sudish C. Murthy Source Type: research

Surgical Management of Chest Wall Sarcoma
Chest wall sarcoma is a rare and challenging pathology best managed by a multidisciplinary team experienced in the management of a multiple different pathologies. Knowledge of the management sequence is important for each sarcoma type in order to provide optimal treatment. Surgical resection of chest wall resections remains the primary treatment of disease isolated to the chest wall. Optimal margins of resection and reconstruction techniques have yet to be determined. (Source: Surgical Oncology Clinics of North America)
Source: Surgical Oncology Clinics of North America - August 11, 2020 Category: Surgery Authors: Nathan W. Mesko, Alejandro C. Bribriesco, Daniel P. Raymond Source Type: research

Multidisciplinary Evaluation and Management of Early Stage Esophageal Cancer
Early esophageal cancer involves the mucosal and submucosal layers of the esophagus. Early esophageal cancer is a heterogeneous group, and achieving optimal outcomes requires a multidisciplinary approach to align patients to their optimal treatment. Although organ-sparing endoscopic resection has become the preferred management option for superficial esophageal cancer, it is not adequate in all tumors, such as high-risk lesions with poorly differentiated pathology, lymphovascular invasion, or deep submucosal invasion. In such high-risk lesions, surgery, chemotherapy, and/or radiation may be required. In this article, we pr...
Source: Surgical Oncology Clinics of North America - August 11, 2020 Category: Surgery Authors: Amit Bhatt, Suneel Kamath, Sudish C. Murthy, Siva Raja Source Type: research

Siewert III Adenocarcinoma
It remains uncertain whether Siewert III tumors should be treated as esophageal or gastric cancers. Neoadjuvant therapy has been shown to improve survival in both esophageal and gastric trials. Randomized control trials comparing neoadjuvant chemotherapy versus chemoradiation should help define the most optimal treatment regimen. Surgical treatment follows general oncology principals: resect to negative margins with complete lymph node dissection, and, the extent of resection often extends more proximal onto the esophagus in addition to the total/subtotal gastrectomy. (Source: Surgical Oncology Clinics of North America)
Source: Surgical Oncology Clinics of North America - August 11, 2020 Category: Surgery Authors: Andrew Tang, Davendra Sohal, Michael McNamara, Sudish C. Murthy, Siva Raja Source Type: research

Thymic Malignancy —Updates in Staging and Management
Thymomas are relatively indolent tumors that present with locally advanced disease in 30% of the patients. Thymic carcinoma is a more aggressive histology with shorter disease-free and overall survival. Early-stage tumors are managed best with complete resection. Multimodal therapy is the standard of care for locally advanced tumors and neoadjuvant therapy may help improve respectability. Stage and complete resection are the strongest prognostic factors for long-term survival. Based on early experience, targeted and immunotherapies have shown limited promise in advanced disease. (Source: Surgical Oncology Clinics of North America)
Source: Surgical Oncology Clinics of North America - August 10, 2020 Category: Surgery Authors: Jesse M.P. Rappaport, James Huang, Usman Ahmad Source Type: research

Updates in Thoracic Surgery and Oncology
Surgery of the chest, particularly extirpative surgery for malignancy, is uniquely complex. Cancers are aggressive, and resectability is limited by both anatomic constraints and patient performance status. Unfortunately, locoregional as well as systemic recurrences are common with limited salvage options. The last 2 decades has seen tremendous advancements in thoracic oncology. Early detection and screening have reduced mortality for early esophageal and lung cancers. Moreover, locally advanced and systemic disease can be treated with targeted therapeutics and now immunotherapy. (Source: Surgical Oncology Clinics of North America)
Source: Surgical Oncology Clinics of North America - August 10, 2020 Category: Surgery Authors: Usman Ahmad, Sudish C. Murthy Tags: Preface Source Type: research

Updates in Staging and Management of Malignant Pleural Mesothelioma
While without treatment, malignant pleural mesothelioma (MPM) confers poor survival, cancer-directed surgery as part of multimodality treatment is associated with a 15% 5-year survival. Extrapleural pneumonectomy (EPP) and radical or extended pleurectomy/decortication (P/D) are the 2 types of resection performed in this context. Preoperative staging is critical to patient selection for surgery; P/D is recommended over EPP in most cases. Adjuvant therapy with intraoperative platforms, traditional chemotherapy, hemithoracic radiotherapy resection, and new immunotherapy agents are instrumental in achieving durable long-term r...
Source: Surgical Oncology Clinics of North America - August 9, 2020 Category: Surgery Authors: Andrea S. Wolf, Raja M. Flores Source Type: research

Emerging Therapies in Thoracic Malignancies
This issue of the Surgical Oncology Clinics of North America covers the important topic of Emerging Therapies in Thoracic Malignancies. Thoracic cancers include a broad range of malignancies, such as lung cancers, mediastinal tumors, chest wall sarcomas, as well as thymic and tracheal lesions. Similar to the diverse types of cancers contained within the rubric of “thoracic malignancies,” the surgical procedures, systemic treatments, staging systems, as well as prognoses of these different diseases are varied. (Source: Surgical Oncology Clinics of North America)
Source: Surgical Oncology Clinics of North America - August 9, 2020 Category: Surgery Authors: Timothy M. Pawlik Tags: Foreword Source Type: research

Emerging Therapies in Thoracic Malignancies —Immunotherapy, Targeted Therapy, and T-Cell Therapy in Non–Small Cell Lung Cancer
This article discusses the current state of novel treatment options for non –small cell lung cancer patients with metastatic and locoregional disease, with focus on immunotherapy, targeted therapy, and adoptive T-cell therapy. (Source: Surgical Oncology Clinics of North America)
Source: Surgical Oncology Clinics of North America - July 28, 2020 Category: Surgery Authors: Boris Sepesi, Tina Cascone, Stephen G. Chun, Mehmet Altan, Xiuning Le Source Type: research

Evaluation of Risk for Thoracic Surgery
This article reviews the latest evidence relating to risk assessment in thoracic surgery and suggests how this should be incorporated into clinical practice. (Source: Surgical Oncology Clinics of North America)
Source: Surgical Oncology Clinics of North America - July 20, 2020 Category: Surgery Authors: Alessandro Brunelli, Michael R. Gooseman, Cecilia Pompili Source Type: research

Management of Locally Advanced Esophageal Cancer
Management of locally advanced esophageal cancer is evolving. Trimodality therapy with chemoradiation followed by surgical resection has become the standard of care. However, the value of planned surgery after response to therapy is in question. In this article, we discuss the current practice principles and evidence for the treatment of locally advanced esophageal cancer. Topics will include various neoadjuvant therapies, trimodality versus bimodality therapy, and outcomes for salvage esophagectomies. In addition, emerging novel therapies, such as HER2 inhibitors and immunotherapy, are available for unresectable or metast...
Source: Surgical Oncology Clinics of North America - July 20, 2020 Category: Surgery Authors: Nicolas Zhou, Ravi Rajaram, Wayne L. Hofstetter Source Type: research

Intraoperative Detection and Assessment of Lung Nodules
Lung cancer is the most frequent cause of cancer-related death worldwide. Despite advances in systemic therapy, the 5-year survival remains humbling at 4% to 17%. For those diagnosed early, surgical therapy can yield potentially curative results. Surgical resection remains a cornerstone of medical care. Success hinges on sound oncologic resection principles. Various techniques can be used to identify pulmonary nodules. A challenge is intraoperative assessment of the surgical specimen to confirm disease localization and ensure an R0 resection. The primary tool is frozen section. Understanding the options available enhances ...
Source: Surgical Oncology Clinics of North America - July 20, 2020 Category: Surgery Authors: Feredun Azari, Greg Kennedy, Sunil Singhal Source Type: research

Lung Cancer Screening
Lung cancer is the leading cause of US cancer-related deaths. Lung cancer screening with a low radiation dose chest computed tomography scan is now standard of care for a high-risk eligible population. It is imperative for clinicians and surgeons to evaluate the trade-offs of benefits and harms, including the identification of many benign lung nodules, overdiagnosis, and complications. Integration of smoking cessation interventions augments the clinical benefits of screening. Screening programs must develop strategies to manage screening-detected findings to minimize potential harms. Further research should focus on how to...
Source: Surgical Oncology Clinics of North America - July 19, 2020 Category: Surgery Authors: Humberto K. Choi, Peter J. Mazzone Source Type: research

Mediastinal Germ Cell Tumors
Primary mediastinal nonseminomatous germ cell tumors represent a rare but important malignancy that occurs in otherwise young and healthy patients. Treatment is challenging and involves cisplatin-based chemotherapy followed by surgery to remove residual disease. Avoiding bleomycin-containing chemotherapy in the treatment of primary mediastinal nonseminomatous germ cell tumors is important. Prechemotherapy and postchemotherapy pathology as well as postoperative serum tumor markers are independent predictors of long-term survival. (Source: Surgical Oncology Clinics of North America)
Source: Surgical Oncology Clinics of North America - July 19, 2020 Category: Surgery Authors: Amanda R. Stram, Kenneth A. Kesler Source Type: research

Margins of Melanoma Excision and Modifications to Standards
Surgery with wide local excision is the mainstay of treatment for primary melanoma. Surgical margins differ depending on the depth of the primary lesion, subtype, and anatomic, cosmetic, or functional considerations. Adjuncts or alternative treatments to wide local excision are limited to specific patient populations and mainly experimental in nature. (Source: Surgical Oncology Clinics of North America)
Source: Surgical Oncology Clinics of North America - May 30, 2020 Category: Surgery Authors: Brock B. Hewitt, Emma Bradley, Adam C. Berger Source Type: research

Reconstructive Techniques in Melanoma for the Surgical Oncologist
This article provides a broad overview of preoperative patient, timing, and wound considerations; various surgical techniques for complex reconstruction throughout the body; and postoperative care and complication management. (Source: Surgical Oncology Clinics of North America)
Source: Surgical Oncology Clinics of North America - May 30, 2020 Category: Surgery Authors: Alejandro R. Gimenez, Sebastian J. Winocour, Carrie K. Chu Source Type: research

Management of Noncutaneous Melanomas
Noncutaneous melanomas are rare subtypes of melanoma with high rates of metastatic disease and poor overall survival. One-third to one-half of cases are amelanotic, which may contribute to a delay in diagnosis. Immunohistochemistry staining with typical melanoma markers helps confirm the diagnosis. There is no standard staging system across mucosal melanomas. Elective nodal dissection is not recommended and there is a paucity of data to support use of sentinel lymph node biopsy. Mutational analysis should be routinely performed. Systemic therapy options include targeted inhibitors, immunotherapy, and cytotoxic chemotherapy...
Source: Surgical Oncology Clinics of North America - May 30, 2020 Category: Surgery Authors: Ann Y. Lee, Russell S. Berman Source Type: research

Age and Melanocytic Lesions
Age plays a dynamic role in incidence, presentation, and extent of disease for cutaneous melanoma. Even within the spectrum of juvenile melanoma, there exists a range of spitzoid and nonspitzoid melanocytic and melanoma lesions. Spitzoid melanomas, a more favorable disease in juvenile patients, are malignant lesions and require treatment as such. Lymph node metastases in melanoma occur at lower rates in older patients compared with younger counterparts, yet the rate of metastases is still high. Age appears to play an important role in the development and progression of melanoma, and understanding the differences across age...
Source: Surgical Oncology Clinics of North America - May 30, 2020 Category: Surgery Authors: Adrienne B. Shannon, Yun Song, Xiaowei Xu, Giorgos C. Karakousis Source Type: research

Sentinel Lymph Node Biopsy
Sentinel lymph node biopsy is a key tool in the care of many patients with melanoma. The indications for the procedure have gradually become clearer over the 3  decades since the technique was developed. For appropriately selected patients, it carries enormous significance. Although it is a minimally invasive procedure, it does carry some risk. It is also a multidisciplinary procedure, requiring knowledge and experience from several specialties including nuclear medicine, surgery, and pathology. (Source: Surgical Oncology Clinics of North America)
Source: Surgical Oncology Clinics of North America - May 30, 2020 Category: Surgery Authors: Jessica Crystal, Mark B. Faries Source Type: research

Management of Regional Nodal Melanoma
Regional nodal melanoma management has changed substantially over the past 2  decades alongside advances in systemic therapy. Significant data from retrospective studies and from 2 randomized controlled trials show no survival benefit to completion lymph node dissection compared with observation in sentinel lymph node–positive melanoma patients. Observation is becoming th e standard recommendation in these patients, whereas patients with clinically detected lymph nodes are still recommended to undergo lymph node dissection. Promising early results from a neoadjuvant approach inform the ongoing evolution of melan...
Source: Surgical Oncology Clinics of North America - May 30, 2020 Category: Surgery Authors: Christina V. Angeles, Sandra L. Wong Source Type: research

Injectable Therapies for Regional Melanoma
Patients with unresectable cutaneous, subcutaneous, or nodal melanoma metastases are often candidates for injectable therapies, which are attractive for ease of intralesional delivery to superficial metastases and limited systemic toxicity profiles. Injectable or intralesional therapies can be part of multifaceted treatment strategies to kill tumor directly or to alter the tumor so as to make it more sensitive to systemic therapy. Talimogene laherparepvec is the only Food and Drug Administration –approved injectable therapy currently in wide clinical use in the United States, although ongoing trials are evaluating no...
Source: Surgical Oncology Clinics of North America - May 30, 2020 Category: Surgery Authors: Norma E. Farrow, Margaret Leddy, Karenia Landa, Georgia M. Beasley Source Type: research

Adjuvant Therapy for Cutaneous Melanoma
This article presents the current data supporting adjuvant therapy for patients with cutaneous melanoma. With the recent development of novel immunotherapy agents as well as targeted therapy, there are strong data to support the use of these therapies in patients at high risk of developing recurrent or metastatic disease. (Source: Surgical Oncology Clinics of North America)
Source: Surgical Oncology Clinics of North America - May 30, 2020 Category: Surgery Authors: Darryl Schuitevoerder, Charles C. Vining, Jennifer Tseng Source Type: research

Role of Surgery in Stage IV Melanoma
Stage IV melanoma has a 5-year survival rate of 6%, but considerable advances have been made in systemic therapies. Systemic immunotherapy has achieved durable responses in up to 40% of patients, with similar improvements with targeted therapies. This has reshaped the landscape for surgery in stage IV melanoma. Metastasectomy can be considered in patients on systemic immunotherapy or targeted therapy with responding, stable, or isolated progressing lesions, oligometastatic disease, or long disease-free intervals. Surgery plays a role in providing tumor tissue for preparation of tumor-infiltrating lymphocytes for adoptive c...
Source: Surgical Oncology Clinics of North America - May 30, 2020 Category: Surgery Authors: Conor H. O ’Neill, Kelly M. McMasters, Michael E. Egger Source Type: research

Novel Targets in Melanoma
Clinical outcomes for metastatic melanoma have been dramatically altered by recent developments in immunotherapy and targeted strategies, but response to these therapies is not uniform, the majority of patients do not respond, and clinical response can be self-limited. Current directions in melanoma treatment aim to leverage a combination of therapies for tumors refractory to monoimmunotherapy, to include tumor-directed strategies, such as intralesional therapy and inhibitors designed for novel targets, which may augment current systemic agents when used in combination. Here, we summarize new classes of agents and emerging...
Source: Surgical Oncology Clinics of North America - May 30, 2020 Category: Surgery Authors: Alicia A. Gingrich, Amanda R. Kirane Source Type: research