Patients who receive the standard surgical treatment for melanoma that has spread to one or more key lymph nodes do not live longer, according to a study published in the New England Journal of Medicine (NEJM).
The study found that a complete lymph node dissection did not result in increased overall survival rates for patients.
"The new findings likely will result in many fewer of these procedures being performed around the world," said lead author Mark B. Faries, MD, Melanoma Program, Cedars-Sinai Medical Center, Los Angeles, California. "The results also will likely affect the design of many current and future clinical trials of medical therapies in melanoma."
More than 1,900 patients with melanoma participated in the study conducted at more than 60 medical institutions nationally and internationally.
The study, among the largest ever conducted on melanoma, examines what Dr. Faries describes as the most important question facing physicians and those newly diagnosed with the disease: whether patients who have melanoma cells in a limited number of lymph nodes should undergo extensive surgery to remove all the remaining nodes in that area of the body. The results of the new research suggest they do not.
"This new approach spares patients significant negative side effects and clarifies the road forward in development of additional therapies," said Omid Hamid, MD, Cedars Sinai Medical Center. "Dr. Faries and colleagues' contribution to the field of surgical oncology cannot be overstated."
Although the completion dissections did not help overall survival, they did have some value, said Dr. Faries. By examining the dissected lymph nodes, physicians were able to better gauge how extensively the cancer had spread and to lengthen the time that their patients were disease-free. But those advantages did not translate into longer lives.
In addition, nearly 25% of the patients who underwent the completion dissections suffered from lymphedema, compared with about 6% of the control group.
"This is a larger operation that has a higher risk of complications, including wound infection and nerve damage," said Dr. Faries.
Prior to the now-common sentinel node biopsy procedure, dissection of all regional lymph nodes at the early diagnosis of melanoma was the standard of care. Today, lymphatic mapping techniques are applied worldwide, and the removal of all regional nodes is undertaken only if the sentinel nodes are positive for cancer.
"The larger procedure will remain an option for some patients, but it will no longer be the only 'standard' option," said Dr. Faries.
SOURCE: Cedars-Sinai Medical Center
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