Melanoma Patients with Positive Sentinel Nodes Who Did Not Undergo Completion Lymphadenectomy: A Multi-Institutional Study |
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| Authors: | Sandra L Wong MD Donald L Morton MD John F Thompson MD Jeffrey E Gershenwald MD Stanley P L Leong MD Douglas S Reintgen MD Haim Gutman MD Michael S Sabel MD Grant W Carlson MD Kelly M McMasters MD PhD Douglas S Tyler MD James S Goydos MD Alexander M M Eggermont MD PhD Omgo E Nieweg MD PhD A Benedict Cosimi MD Adam I Riker MD Daniel G Coit MD |
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| Institution: | (1) Department of Surgery, Memorial Sloan-Kettering Cancer Center, 1275 York Avenue, New York, New York, 10021;(2) Department of Surgery, John Wayne Cancer Institute, Santa Monica, California;(3) Sydney Melanoma Unit, Royal Prince Alfred Hospital, Sydney, Australia;(4) Department of Surgery, M. D. Anderson Cancer Center, Houston, Texas;(5) Department of Surgery, University of California at San Francisco, San Francisco, California;(6) Department of Surgery, Lakeland Regional Cancer Center, Lakeland, Florida;(7) Department of Surgery, Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel;(8) Department of Surgery, University of Michigan, Ann Arbor, Michigan;(9) Department of Surgery, Emory University, Atlanta, Georgia;(10) Department of Surgery, University of Louisville, Louisville, Kentucky;(11) Department of Surgery, Duke University, Durham, North Carolina;(12) Department of Surgery, University of Medicine and Dentistry of New Jersey-Robert Wood Johnson Medical School, New Brunswick, New Jersey;(13) Department of Surgery, Erasmus University Medical Center, Rotterdam, The Netherlands;(14) Department of Surgery, The Netherlands Cancer Institute/Antoni van Leeuwenhoek Hospital, Amsterdam, The Netherlands;(15) Department of Surgery, Massachusetts General Hospital, Boston, Massachusetts;(16) Department of Surgery, Moffitt Cancer Center, University of South Florida, Tampa, Florida |
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| Abstract: | Background Completion lymph node dissection (CLND) is considered the standard of care in melanoma patients found to have sentinel lymph
node (SLN) metastasis. However, the therapeutic utility of CLND is not known. The natural history of patients with positive
SLNs who do not undergo CLND is undefined. This multi-institutional study was undertaken to characterize patterns of failure
and survival rates in these patients and to compare results with those of positive-SLN patients who underwent CLND.
Methods Surgeons from 16 centers contributed data on 134 positive-SLN patients who did not undergo CLND. SLN biopsy was performed
by using each institution’s established protocols. Patients were followed up for recurrence and survival.
Results In this study population, the median age was 59 years, and 62% were male. The median tumor thickness was 2.6 mm, 77% of tumors
had invasion to Clark level IV/V, and 33% of lesions were ulcerated. The primary melanoma was located on the extremities,
trunk, and head/neck in 45%, 43%, and 12%, respectively. The median follow-up was 20 months. The median time to recurrence
was 11 months. Nodal recurrence was a component of the first site of recurrence in 20 patients (15%). Nodal recurrence–free
survival was statistically insignificantly worse than that seen in a contemporary cohort of patients who underwent CLND. Disease-specific
survival for positive-SLN patients who did not undergo CLND was 80% at 36 months, which was not significantly different from
that of patients who underwent CLND.
Conclusions This study underscores the importance of ongoing prospective randomized trials in determining the therapeutic value of CLND
after positive SLN biopsy in melanoma patients.
Presented at the 58th Annual Cancer Symposium of the Society of Surgical Oncology, Atlanta, Georgia, March 3–6, 2005. |
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| Keywords: | Melanoma Sentinel lymph node biopsy Completion lymphadenectomy Recurrence Survival |
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