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Cancer Resources > Cancer News > 2006 > September
Melanoma treatment based on sentinel-node biopsy may prolong survival
Last Updated: 2006-09-27 17:02:51 -0400 (Reuters Health)
NEW YORK (Reuters Health) - Among patients with clinically localized, primary cutaneous melanomas 1.2 to 3.5 mm in thickness, sentinel lymph node biopsy identifies micrometastases requiring lymphadenopathy earlier than they would be revealed if the patients underwent lymphadenectomy only after nodal recurrences become clinically detectable, according to interim results of the Multicenter Selective Lymphadenectomy Trial (MSLT).
As a result, immediate lymphadenectomy based on biopsy results at the same time as tumor resection significantly prolongs survival, members of the MSLT group report in the New England Journal of Medicine for September 28.
The study group, led by Dr. Donald L. Morton, enrolled patients residing in North America, Europe and Australia, who presented between 1994 and 2002 with primary melanomas 1.2 to 3.5 mm in thickness. The investigators randomly assigned 814 patients to undergo wide excision and sentinal node biopsy and 511 to wide excision and nodal observation.
The primary end point -- 5-year melanoma-specific survival rate -- was greater when lymphadenectomy was performed sooner: 78.3% versus 73.1%, hazard ratio (HR) = 0.74, p = 0.009.
The number of patients with positive lymph nodes was similar between groups (16.0% versus 15.6%). However, the average number of positive lymph nodes was 1.4 in the biopsy group, compared with the 3.3 in the observation only group, suggesting increased disease progression in the observation group. The biopsy group patients who underwent lymphadenectomy also had lower nodal stages than did those in the observation group.
In the biopsy group, the presence of metastases in the sentinel node was the most important prognostic factor. The 5-year survival rate was 72.3% among those with positive sentinel nodes and 90.1% among those with tumor-negative nodes (HR = 2.48, p < 0.0001).
Finally, among patients with nodal metastasis, the 5-year survival rate was 72.3% among those in the biopsy group versus 52.4% in the observation group (HR for death = 0.51, p = 0.004; HR for melanoma recurrence = 3.04, p < 0.001).
"Our results confirm that sentinel-node biopsy has a high value for staging clinically localized, intermediate-thickness melanoma and provides a more accurate basis for formulating a prognosis than do standard demographic and histopathological factors," Dr. Morton and his associates conclude.
In an editorial, Dr. Charles M. Balch and Dr. Natalie Cascinelli call this report "the largest and most important trial of sentinal-lymph node biopsy for melanoma conducted to date."
Moreover, add Dr. Balch, from Johns Hopkins Medical Institutions in Baltimore, and Dr. Cascinelli, from the National Tumor Institute in Milan, Italy, these results "convincingly show that sentinel-node biopsy is a standard-of-care staging procedure and is justified in patients with melanoma with tumor thickness of 1.2 to 3.5 cm."
N Engl J Med 2006;355:1207-1217,1370-1371.
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