Patients with melanoma who underwent a surgical procedure called immediate completion lymph node dissection — the removal of all lymph nodes around the tumor — did not live any longer than patients who were instead closely monitored, according to a new study published in the New England Journal of Medicine.
Subjects in the clinical trial all had melanoma that had metastasized to the sentinel node, the first involved in lymphatic spread.
Sentinel node biopsies are performed on patients with melanoma to help understand whether the cancer might have spread to nearby lymph nodes. If these key lymph nodes are found to be cancerous, patients also typically undergo completion lymph node dissection, where all other lymph nodes in the area are removed and biopsied.
But the procedure can carry significant adverse effects, and there has been little evidence showing a survival benefit.
In the current international study, more than 1,900 patients with melanoma and sentinel-node metastasis were randomized to either receive an immediate dissection, or undergo observation with ultrasounds every four to six months. In that group, surrounding nodes were only removed if cancer was detected.
At three years follow-up, the investigators found no difference in melanoma-specific survival between the two groups.
Further, patients who had received the dissection were significantly more likely to develop lymphedema, a common complication of the procedure where lymphatic system blockage causes painful swelling in the arms and legs.
Although the primary endpoint was patient survival, the study did find some small benefits to the dissections: disease-free survival rates were slightly higher in the dissection group, and the procedure also provided physicians with increased prognostic information.
Wayne is also associate director of clinical affairs for the Robert H. Lurie Comprehensive Cancer Center of Northwestern University.
The research was supported by grants CA189163 and CA29605 from the National Cancer Institute and funding from the Borstein Family Foundation, the Amyx Foundation, the Dr. Miriam and Sheldon G. Adelson Medical Research Foundation and the John Wayne Cancer Institute Auxiliary.