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Purpose The aim of this study was to assess the independent prognostic value of primary tumor mitotic rate compared with other clinical and pathologic features of stages I and II melanoma. Methods From the American Joint Committee on Cancer (AJCC) melanoma staging database, information was extracted for 13,296 patients with stages I and II disease who had mitotic rate data available. Results Survival times declined as mitotic rate increased. Ten-year survival ranged from 93% for patients whose tumors had 0 mitosis/mm2 to 48% for those with ≥ 20/mm2 (P < .001). Mean number of mitoses/mm2 increased as the primary melanomas became thicker (1.0 for melanomas ≤ 1 mm, 3.5 for 1.01 to 2.0 mm, 7.3 for 3.01 to 4.0 mm, and 9.6 for > 8 mm). Ulceration was also associated with a higher mitotic rate; 59% of ulcerated melanomas had ≥ 5 mitoses/mm2 compared with 16% of nonulcerated melanomas (P < .001). In a multivariate analysis of 10,233 patients, the independent predictive factors for survival in order of statistical significance were as follows: tumor thickness (χ2 = 104.9; P < .001), mitotic rate (χ2 = 67.0; P < .001), patient age (χ2 = 48.2; P < .001), ulceration (χ2 = 46.4; P < .001), anatomic site (χ2 = 34.6; P < .001), and patient sex (χ2 = 33.9; P < .001). Clark level of invasion was not an independent predictor of survival (χ2 = 3.2; P = .37). Conclusion A high mitotic rate in a primary melanoma is associated with a lower survival probability. Among the independent predictors of melanoma-specific survival, mitotic rate was the strongest prognostic factor after tumor thickness.

Purpose To assess whether a new method of quantifying therapy-associated hemodynamic alterations may help to distinguish pseudoprogression from true progression in patients with high-grade glioma. Patients and Methods Patients with high-grade glioma received concurrent chemoradiotherapy. Relative cerebral blood volume (rCBV) and blood flow (rCBF) maps were acquired before chemoradiotherapy and at week 3 during treatment on a prospective institutional review board–approved study. Pseudoprogression was defined as imaging changes 1 to 3 months after chemoradiotherapy that mimic tumor progression but stabilized or improved without change in treatment or for which resection revealed radiation effects only. Clinical and conventional magnetic resonance (MR) parameters, including average percent change of rCBV and CBF, were evaluated as potential predictors of pseudoprogression. Parametric response map (PRM), an innovative, voxel-by-voxel method of image analysis, was also performed. Results Median radiation dose was 72 Gy (range, 60 to 78 Gy). Of 27 patients, stable disease/partial response was noted in 13 patients and apparent progression was noted in 14 patients. Adjuvant temozolomide was continued in all patients. Pseudoprogression occurred in six patients. Based on PRM analysis, a significantly reduced blood volume (PRMrCBV) at week 3 was noted in patients with progressive disease as compared with those with pseudoprogression (P < .01). In contrast, change in average percent rCBV or rCBF, MR tumor volume changes, age, extent of resection, and Radiation Therapy Oncology Group recursive partitioning analysis classification did not distinguish progression from pseudoprogression. Conclusion PRMrCBV at week 3 during chemoradiotherapy is a potential early imaging biomarker of response that may be helpful in distinguishing pseudoprogression from true progression in patients with high-grade glioma.

PURPOSE To assess prospectively the accuracy of 2-[l8F]-2-deoxy-D-glucose positron emission tomography (FDG-PET) for predicting regional node involvement in cutaneous malignant melanoma (CMM). PATIENTS AND METHODS Twenty-three patients with CMM (primary lesions > 1.5 mm thick) scheduled for lymph node dissection (LND) were preoperatively studied with FDG-PET. Thirteen patients underwent therapeutic LND of 14 node basins, while nine patients had elective LND of 10 node basins. Medical problems precluded surgery in one patient. Two observers unaware of the clinical node status-apart from whether a recent surgical scar was present-read attenuation-corrected reconstructed transverse images acquired between 50 and 60 minutes after injection. Intensity of FDG uptake was scored as 0 to 3 + on a semiquantitative four-point scale: 0, no uptake; 1 +, faint; 2 +, moderate; and 3 +, intense uptake. A node group was considered positive on FDG-PET if it contained at least one focus of FDG uptake of > or = 2+ intensity. Histopathologic examination of the 24 dissected node groups served as a reference. RESULTS Considering regional node basins, PET imaging demonstrated 11 true-positive (TP), 10 true-negative (TN), two false-negative (FN), and one false-positive (FP) result, for an overall accuracy of 88%. Histopathologic from one FN case showed seven malignant cells in a marginal node sinus. The FP was due to reactive changes postbiopsy. In one patient, clinically involved lymph nodes were correctly categorized TN by PET. At least four additional 2 + foci seen outside the dissected regions on PET may represent metastases and are being monitored. CONCLUSION FDG-PET accurately predicted regional node status in 88% of CMM cases. The failure to detect micrometastatic disease may be due to the limitations of the imaging equipment and technique used here.

9088 Background: While SLN biopsy is considered standard of care for melanoma ≥1mm in depth, its use among the elderly population is more controversial. To examine this, we reviewed our experience ...

2068 Background: Patients diagnosed with a malignant glioma continue to have a poor prognosis. Our previous research has shown that therapeutic-associated alterations in tumor cellularity and hemod...

1518 Background: Current assessment of glioma treatment response relies on changes in the product of the maximal perpendicular tumor diameters at 2 months following treatment. Due to the fact that patients with malignant glioma have high mortality rates and a short median survival (about 41 weeks), the ability to stratify these tumors into responsive and non-responsive categories prior to treatment completion would allow for individualization of treatment. Changes in glioma water diffusion values were quantified using diffusion MRI as a biomarker for therapeutic-induced changes in tumor cellularity. Methods: A total of 37 patients with Grade III/IV supratentorial malignant gliomas (restricted to anaplastic astrocytomas (Grade III) and glioblastomas/sarcomas (Grade IV)) into a clinical imaging study. Standard and diffusion MRI scans pre-treatment and at 3 weeks post-initiation of chemo- and/or radio-therapy were acquired. Images were co-registered to pretreatment scans, and changes in tumor water diffusion values were calculated and displayed as a functional diffusion map (fDM) for correlation with clinical response. Results: Analysis of the patient data revealed that the fDM volumes of total detected diffusion change (VT) was able to statistically discriminate (P [Table: see text]