CLND Fails to Improve Melanoma Survival Rates

A new study shows that immediate completion lymph-node dissection (CLND) does not increase survival among patients with melanoma and sentinel-node metastases.

Researchers at the John Wayne Cancer Institute (JWCI; Santa Monica, CA, USA), Sentara CarePlex Hospital (Hampton, VA, USA), and other institutions worldwide conducted a study that randomly assigned 1,934 patients with sentinel-node metastases--detected via standard pathological assessment or a multimarker molecular assay--to immediate CLND or to an observation group monitored with ultrasonography. Main outcomes and measures were melanoma-specific survival, disease-free survival, and cumulative rate of non-sentinel-node metastasis.

The results showed that Immediate CLND was not associated with increased melanoma-specific survival. In the per-protocol analysis, the mean three-year rate of melanoma-specific survival was similar in the dissection group and the observation group (86%) at a median follow-up of 43 months. The mean rate of disease-free survival was slightly higher in the dissection group (68%) than in the observation group (63%) at three years. Lymphedema was observed in 24.1% of the patients in the dissection group and in 6.3% of those in the observation group. The study was published on June 8, 2017, in the New England Journal of Medicine (NEJM).

“Although the completion dissections did not help overall survival, they did have some value. 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,” said lead author Mark Faries, MD, of JWCI. “The new findings likely will result in many fewer of these procedures being performed around the world. The results also will likely affect the design of many current and future clinical trials of medical therapies in melanoma.”

Lymph nodes, located throughout the body, serve as biologic filters that contain immune cells that fight infection and clean the blood. When cancer cells break away from a tumor, the cells can travel through the lymph system; sentinel node surgery allows the surgeon to remove the nodes to determine cancer spread. As human nodes are only 5 mm in size, they are difficult to discern from the surrounding tissue during surgery. Furthermore, even when surgeons are able to map the location of the nodes, there is no current technique that indicates whether or not the lymph nodes contain cancer, requiring removal of more lymph nodes than necessary.

Related Links:
John Wayne Cancer Institute
Sentara CarePlex Hospital