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. 2022 Dec;7(6):100600.
doi: 10.1016/j.esmoop.2022.100600. Epub 2022 Oct 17.

The meaning of screening: detection of brain metastasis in the adjuvant setting for stage III melanoma

S H A E Derks  1 , K de Joode  2 , E E A P Mulder  3 , L S Ho  4 , A Joosse  5 , M J A de Jonge  6 , C Verhoef  7 , D J Grünhagen  7 , M Smits  8 , M J van den Bent  9 , A A M van der Veldt  10
Affiliations

The meaning of screening: detection of brain metastasis in the adjuvant setting for stage III melanoma

S H A E Derks et al. ESMO Open. 2022 Dec.

Abstract

Background: The incidence of melanoma is increasing and 37% of patients with metastatic melanoma eventually have brain metastasis (BM). Currently, there is no consensus on screening for BM in patients with resected stage III melanoma. However, given the high incidence of BM, routine screening magnetic resonance imaging (MRI) of the brain is considered in patients with completely resected stage III melanoma before the start of adjuvant treatment. The aim of this study was to assess the yield of screening for BM in these patients.

Materials and methods: A single-center cohort study was carried out in the Erasmus MC, Rotterdam, The Netherlands, a large tertiary referral center for patients with melanoma. Eligible patients with complete resection of stage III melanoma and a screening MRI of the brain, made within 12 weeks after resection and before adjuvant treatment (programmed cell death protein 1 inhibitors, dabrafenib-trametinib), available between 1 August 2018 and 1 January 2021, were included.

Results: A total of 202 patients were included. Eighteen (8.9%) of 202 patients had extracranial metastasis at screening. Two (1.1%) of the remaining 184 patients had BM at screening, resulting in a switch from adjuvant treatment to ipilimumab-nivolumab. At a median follow-up of 21.2 months, BM was detected in another 4 (2.4%) of 166 patients who started with adjuvant treatment.

Conclusions: The yield of screening MRI of the brain is low after complete resection of stage III melanoma, before the start of adjuvant treatment. Therefore, routine screening MRI is not recommended in this setting.

Keywords: MRI of the brain; adjuvant treatment; brain metastasis; dabrafenib–trametinib; melanoma; nivolumab; pembrolizumab; screening; stage III.

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Conflict of interest statement

Disclosure AAMvdV: consultancy boards (fees paid to the institution) for BMS, MSD, Merck, Sanofi, Pierre Fabre, Roche, Novartis, Pfizer, Eisai, Ipsen. MS: speaker fee (paid to the institution) from AuntMinnie. All other authors have declared no conflicts of interest.

Figures

Figure 1
Figure 1
Bar chart of all patients with complete resection of stage III melanoma at restaging before adjuvant treatment (n = 202). Eighteen (8.9%) of 202 patients had extracranial metastasis (ECM) at restaging. Two (1.1%) of the remaining 184 patients had solitary brain metastasis (BM) at restaging.
See this image and copyright information in PMC

References

    1. Sung H., Ferlay J., Siegel R.L., et al. Global cancer statistics 2020: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries. CA Cancer J Clin. 2021;71(3):209–249. - PubMed
    1. Tarhini A., Ghate S., Ionescu-Ittu R., et al. Stage III melanoma incidence and impact of transitioning to the 8th AJCC staging system: a US population-based study. Future Oncol. 2019;15(4):359–370. - PubMed
    1. Garbe C., Leiter U. Melanoma epidemiology and trends. Clin Dermatol. 2009;27(1):3–9. - PubMed
    1. Leeneman B., Franken M.G., Coupé V.M.H., et al. Stage-specific disease recurrence and survival in localized and regionally advanced cutaneous melanoma. Eur J Surg Oncol. 2019;45(5):825–831. - PubMed
    1. Barnholtz-Sloan J.S., Sloan A.E., Davis F.G., Vigneau F.D., Lai P., Sawaya R.E. Incidence proportions of brain metastases in patients diagnosed (1973 to 2001) in the Metropolitan Detroit Cancer Surveillance System. J Clin Oncol. 2004;22(14):2865–2872. - PubMed

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