Ten Best Readings on Radioguided Surgery

Andrea Brobeil and Douglas Reintgen, MD
H. Lee Moffitt Cancer Center & Research Institute
University of South Florida College of Medicine

Balch CM, Soong SJ, Bartolucci AA, et al. Efficacy of an elective regional lymph node dissection of 1 to 4 mm thick melanomas for patients 60 years of age and younger. Ann Surg. 1996;224:255-263.

It had been unclear whether elective lymph node dissection (ELND) offered a survival benefit to melanoma patients with clinically negative nodes. This Intergroup Melanoma Trial found that a subset of patients with primary melanomas between 1.0 and 2.0 mm and/or less than 60 years of age have a documented survival benefit with ELND.

Kirkwood JM, Strawderman MH, Ernstoff MS, et al. Interferon alfa-2b adjuvant therapy for high-risk resected cutaneous melanoma: the Eastern Cooperative Oncology Group Trial EST 1684. J Clin Oncol. 1996;14:7-17.

The authors demonstrate that interferon alfa-2b given after surgical resection of a high-risk melanoma provides extended disease-free and overall survival similar to that achieved by adjuvant therapy for breast and colon cancer.

Cole BF, Gelber RD, Kirkwood JM, et al. Quality-of-life-adjusted survival analysis of interferon alfa-2b adjuvant treatment of high-risk resected cutaneous melanoma: an Eastern Cooperative Oncology Group study. J Clin Oncol. 1996; 14:2666-2673.

Applied to the data from the Eastern Cooperative Oncology Group's trial 1684 on adjuvant interferon alfa-2b therapy in melanoma, the authors found that the group receiving interferon gained quality-adjusted survival time when compared to the control. The interferon-treated group spent twice as much "time without symptoms" than in toxicity and relapse states.

Hillner BE, Kirkwood JM, Atkins MB, et al. Economic analysis of adjuvant interferon alfa-2b in high-risk melanoma based on projections from Eastern Cooperative Oncology Group 1684. J Clin Oncol. 1997;15:2351-2358.

The projected incremental cost per life gained in the interferon group ranged from $43,200 per Q-TWiST year at seven years to $15,200 per Q-TWiST year over a lifetime. This wide range in cost reflects interferon's significant survival advantage at seven years. These costs are comparable to those of other cancer interventions.

Reintgen D, Albertini J, Milliotes, et al. Investment in new technology research can save future health care dollars. J Fla Med Assoc. 1997;84:175-181.

With 38,300 new cases of melanoma diagnosed each year, the lymphatic mapping procedure could potentially save the health care system $172 million per year if general anesthesia is used in the surgical procedure and $350 million per year if local anesthesia is used. In addition, patient morbidity is minimized, nodal staging is complete, and adjuvant therapy can be applied in a selective fashion.

Wang X, Heller R, VanVoorhis N, et al. Detection of submicroscopic lymph node metastases with polymerase chain reaction in patients with malignant melanoma. Ann Surg. 1994;220:768-774.

Reverse transcriptase-polymer-ase chain reaction has been successful in identifying nodal micro-metastases. The discovery of such "submicroscopic" disease can be used to upstage patients from stage II to stage III disease — the subset of patients shown to have a survival benefit with adjuvant interferon alfa-2b therapy.

Giuliano AE, Kirgan DM, Guenther JM, et al. Lymphatic mapping and sentinel lymphadenectomy for breast cancer. Ann Surg. 1994;220: 391-398.

Using intraoperative blue dye mapping, Giuliano's group succeeded in locating 114 sentinel lymph nodes (95.6%) in 174 procedures, as well as accurately predicting nodal status in 109 (95.6%) of 114 cases. This success rate was an improvement from the 71% success rate documented in the initial report of 170 patients, thus reflecting the learning curve.

Albertini JJ, Lyman GH, Cox C, et al. Lymphatic mapping and sentinel node biopsy in the patient with breast cancer. JAMA. 1996; 276:1818-1822.

The success rate of finding an axillary sentinel lymph node using a combination of vital blue dye and radiocolloid mapping was 92% compared with a 71% success rate using blue dye alone, as reported by Giuliano and colleagues. In 67% of the patients who had metastasized, the sentinel lymph node was the only site of disease. Cote RJ, Houchens DP, Hitchcock CL, et al. Intraoperative detection of occult colon cancer micrometastases using ¹²⁵I-radiolabelled monoclonal antibody CC49. Cancer. 1996;77:613-620. This study shows that radioimmunoguided surgery (RIGS)-positive tissue removed at laparotomy is likely to contain metastatic disease and result in a more effective resection and staging of colon cancer. Other reports from the same group have suggested a survival advantage when colon cancer surgery employs this technique.

Cagir B, Mahoney WD, Hayes JR, et al. Supernumerary ectopic parathyroid adenoma: case report and review literature. Contemp Surg. 1996;49:337-341.

In this case, Tc-99m-sestamibi was used in identifying the parathyroid tumor, but the authors also recommend ultrasonography and MRI as noninvasive alternatives. The increased sensitivity of these noninvasive methods offers a viable alternative to unsuccessful initial studies that result in increased operative time and higher cost for both the patient and the health care system.

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