tailieunhanh - Chapter 083. Cancer of the Skin (Part 7)

Treatment of Metastatic Disease Melanoma can metastasize to any internal organ, the brain being a particularly common site. Metastatic melanoma is generally incurable, with survival in patients with visceral metastases generally | Chapter 083. Cancer of the Skin Part 7 Treatment of Metastatic Disease Melanoma can metastasize to any internal organ the brain being a particularly common site. Metastatic melanoma is generally incurable with survival in patients with visceral metastases generally 1 year. Thus the goal of treatment is usually palliation. Patients with soft tissue and nodal metastases fare better than those with liver and brain metastases. Metastases limited to regional nodes AJCC stage III disease warrant a therapeutic lymph node dissection. Surgical excision of a single metastasis to the lung or to a surgically accessible brain site can prolong survival. Stereotactic radiosurgery has been successful in the treatment of isolated brain metastases. Radiation therapy can provide local palliation for recurrent tumors or metastases. Patients who have advanced regional disease limited to a limb may benefit from hyperthermic limb perfusion with melphalan. High complete response rates have been reported and responses are associated with significant palliation of symptoms. A number of drugs and biological therapies have demonstrated minimal antitumor activity 15-20 partial response rates in metastatic melanoma including dacarbazine DTIC the nitrosoureas carmustine BCNU lomustine CCNU and semustine methyl-CCNU platinum analogues such as cisplatin and carboplatin vinca alkaloids such as vincristine vinblastine and vindesine the taxanes paclitaxel and docetaxel IFN-a and interleukin 2 IL-2 . Although limited in efficacy single-agent dacarbazine is still considered the standard treatment. Ongoing trials are attempting to define superior combinations. IL-2 produces response rates similar to those seen with cytotoxic agents however active doses usually cause greater toxicity than chemotherapy. Response rates of 50 have been observed with IL-2 for intracutaneous and subcutaneous disease. Melanoma can express cell-surface antigens that may be recognized by host immune cells. These .