Recurrence and Survival Outcomes After Percutaneous Thermal Ablation of Oligometastatic Melanoma Mariah L. White, MD; Thomas D. Atwell, MD; A. Nicholas Kurup, MD; Grant D. Schmit, MD; Rickey E. Carter, PhD; Jennifer R. Geske, MS; Lisa A. Kottschade, APRN, CNP; Jose S. Pulido, MD; Matthew S. Block, MD, PhD; James W. Jakub, MD; Matthew R. Callstrom, MD, PhD; and Svetomir N. Markovic, MD, PhD Abstract Objectives: To evaluate focal treatment of melanoma metastases and to explore whether any potential extended survival benefit exists in a select patient population. Patients and Methods: All patients who underwent image-guided local thermal ablation of metastatic melanoma over an 11-year period (January 1, 2002, to December 31, 2013) were retrospectively identified using an internally maintained clinical registry. Only patients with oligometastatic stage IV disease amenable to complete ablation of all clinical disease at the time of ablation were included in the analysis. Overall survival and median progression-free survival periods were calculated. Results: Thirty-three patients with primary ocular or nonocular melanoma had 66 metastases treated in the lungs, liver, bones, or soft tissues. Eleven (33%) patients were on systemic medical therapy at the time of the procedure. The median survival time was 3.8 years (range, 0.5-10.5 years), with a 4-year estimated survival of 44.1% (95% CI, 28%-68%). Local recurrence at the ablation site developed in 15.1% (5 of 33) of the patients and 13.6% of the tumors (9 of 66). The median progression-free survival time was 4.4 months (95% CI, 1.4 months to 10.5 years), with an estimated 1-year progression-free survival of 30.3% (95% CI, 18%-51%). A subgroup analysis identified 11 patients with primary ocular melanoma and 22 with nonocular melanoma, with a median survival time of 3.9 years (range, 0.9-4.7 years) and 3.8 years (range, 0.5-10.5 years), respectively (P¼.58). There were no major complications and no deaths within 30 days of the procedure. Conclusion: Selective use of image-guided thermal ablation of oligometastatic melanoma may provide results similar to surgical resection in terms of technical effectiveness and oncologic outcomes with minimal risk. ª 2015 Mayo Foundation for Medical Education and Research n Mayo Clin Proc. 2015;nn(n):1-9 S tage IV (metastatic) melanoma carries a poor prognosis with a median survival period of 6 to 10 months, claiming more than 9000 lives per year in the United States. 1 In general, the treatment for stage IV melanoma consists of systemic medical ther- apy (SMT), similar to that for other stage IV cancers; however, until recently, most SMTs have not demonstrated any long-term survival benefit. 1-5 New, both approved and investiga- tional, targeted immunologic therapies have shown promise in recent trials. 6-9 Most notably, programmed cell death inhibitors have shown a durable survival benefit and improvements in progression-free and overall survival (OS). 6,9-12 There is evidence that aggressive focal treat- ment in patients with oligometastatic disease with complete eradication of all clinical disease can result in durable remissions and potentially improve the OS. 13-18 Oligometastatic disease is typically defined as metastatic disease limited to 5 or fewer lesions. 4,17,19,20 Extirpation or ablation of oligometastatic disease may occur as the primary intervention, at or in conjunction with SMT, when there is a near-complete From the Department of Radiology (M.L.W., T.D.A., A.N.K., G.D.S., M.R.C.), Division of Biomedical Statistics and Informatics (R.E.C., J.R.G.), Division of Medical Oncology (L.A.K., M.S.B., S.N.M.), Depart- ment of Opthalmology (J.S.P.), and Division of Subspecialty General Sur- gery (J.W.J.), Mayo Clinic, Rochester, MN. ORIGINAL ARTICLE Mayo Clin Proc. n XXX 2015;nn(n):1-9 n http://dx.doi.org/10.1016/j.mayocp.2015.10.025 www.mayoclinicproceedings.org n ª 2015 Mayo Foundation for Medical Education and Research 1