title: A phase 2 trial of complete resection for stage IV melanoma: results of Southwest Oncology Group Clinical Trial S9430.
abstract: BACKGROUND
  On the basis of retrospective experience at individual centers, it appears that patients with stage IV melanoma who undergo complete resection have a favorable outcome compared with patients with disseminated stage IV disease. The Southwest Oncology Group (SWOG) performed a prospective trial in patients with metastatic melanoma who were enrolled before complete resection of their metastatic disease and provided prospective outcomes in the cooperative group setting.
  
  
  METHODS
  Based on their physical examination and radiologic imaging studies, patients with a stage IV melanoma judged amenable to complete resection underwent surgery within 28 days of enrollment. All eligible patients were followed with scans (computed tomography or positron emission tomography) every 6 months until relapse and death.
  
  
  RESULTS
  Seventy-seven patients were enrolled from 18 different centers. Of those, 5 patients were ineligible; 2 had stage III disease alone; and 3 had no melanoma in their surgical specimen. In addition, 8 eligible patients had incompletely resected tumor. Therefore, the primary analysis included 64 completely resected patients. Twenty patients (31%) had visceral disease. With a median follow-up of 5 years, the median relapse-free survival was 5 months (95% CI, 3-7 months) whereas median overall survival was 21 months (95% CI, 16-34 months). Overall survivals at 3 and 4 years were 36% and 31%, respectively.
  
  
  CONCLUSIONS
  In a prospective multicenter setting, appropriately selected patients with stage IV melanoma achieved prolonged overall survival after complete surgical resection. Although median relapse-free survival was only 5 months, patients could still frequently undergo subsequent surgery for isolated recurrences. This patient population is appropriate for aggressive surgical therapy and for trials evaluating adjuvant therapy.
authors: Vanderbilt University School of Medicine, Department of Medicine, Nashville, Tennessee, USA. jeff.sosman@vanderbilt.edu
authors: Jeffrey A
authors: JA
authors: Sosman
authors: James
authors: J
authors: Moon
authors: Ralph J
authors: RJ
authors: Tuthill
authors: James A
authors: JA
authors: Warneke
authors: John T
authors: JT
authors: Vetto
authors: Bruce G
authors: BG
authors: Redman
authors: P Y
authors: PY
authors: Liu
authors: Joseph M
authors: JM
authors: Unger
authors: Lawrence E
authors: LE
authors: Flaherty
authors: Vernon K
authors: VK
authors: Sondak
mesh_terms: D000328:Adult; D000368:Aged; D018572:Disease-Free Survival; D005260:Female; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D008545:Melanoma / Q000473:pathology* / Q000601:surgery*; D008875:Middle Aged; D009367:Neoplasm Staging; D018579:Patient Selection; D049268:Positron-Emission Tomography; D011379:Prognosis; D011446:Prospective Studies; D012878:Skin Neoplasms / Q000473:pathology* / Q000601:surgery*; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome; D014481:United States