Adjuvant Therapy for Stage III Melanoma Without Immediate Completion Lymph Node Dissection.
Journal
Annals of surgical oncology
ISSN: 1534-4681
Titre abrégé: Ann Surg Oncol
Pays: United States
ID NLM: 9420840
Informations de publication
Date de publication:
Feb 2022
Feb 2022
Historique:
received:
19
05
2021
accepted:
23
08
2021
pubmed:
20
9
2021
medline:
6
1
2022
entrez:
19
9
2021
Statut:
ppublish
Résumé
For patients with stage III melanoma with occult lymph node metastasis, the use of adjuvant therapy is increasing, and completion lymph node dissection (CLND) is decreasing. We sought to evaluate the use of modern adjuvant therapy and outcomes for patients with stage III melanoma who did not undergo CLND. Patients with a positive SLNB from 2015 to 2020 who did not undergo CLND were evaluated retrospectively. Nodal recurrence, recurrence-free survival (RFS), distant metastasis-free survival (DMFS), and melanoma-specific survival were evaluated. Among 90 patients, 56 (62%) received adjuvant therapy and 34 (38%) underwent observation alone. Patients who received adjuvant therapy were younger (mean age: 53 vs. 65, p < 0.001) and had higher overall stage (Stage IIIb/c 75% vs. 54%, p = 0.041). Disease recurred in 12 of 34 patients (35%) in the observation group and 11 of 56 patients (20%) in the adjuvant therapy group. The most common first site of recurrence was distant recurrence alone (5/34 patients) in the observation group and nodal recurrence alone (8/90 patients) in the adjuvant therapy group. Despite more adverse nodal features in the adjuvant therapy group, 24-month nodal recurrence rate and RFS were not significantly different between the adjuvant and observation cohorts (nodal recurrence rate: 26% vs. 20%, p = 0.68; RFS: 75% vs. 61%, p = 0.39). Among patients with stage IIIb/c disease, adjuvant therapy was associated with a significantly improved 24-month DMFS (86% vs. 59%, p = 0.04). In this early report, modern adjuvant therapy in patients who forego CLND is associated with longer DMFS among patients with stage IIIb/c disease.
Identifiants
pubmed: 34537899
doi: 10.1245/s10434-021-10775-8
pii: 10.1245/s10434-021-10775-8
doi:
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
806-815Commentaires et corrections
Type : CommentIn
Informations de copyright
© 2021. Society of Surgical Oncology.
Références
Morton DL, Thompson JF, Cochran AJ, Mozzillo N, Nieweg OE, Roses DF, et al. Final trial report of sentinel-node biopsy versus nodal observation in melanoma. N Engl J Med. 2014;370(7):599–609.
doi: 10.1056/NEJMoa1310460
Leiter U, Stadler R, Mauch C, Hohenberger W, Brockmeyer N, Berking C, et al. Complete lymph node dissection versus no dissection in patients with sentinel lymph node biopsy positive melanoma (DeCOG-SLT): a multicentre, randomised, phase 3 trial. Lancet Oncol. 2016;17(6):757–67.
doi: 10.1016/S1470-2045(16)00141-8
Faries MB, Thompson JF, Cochran AJ, Andtbacka RH, Mozzillo N, Zager JS, et al. Completion dissection or observation for sentinel-node metastasis in melanoma. N Engl J Med. 2017;376(23):2211–22.
doi: 10.1056/NEJMoa1613210
Herb JN, Dunham LN, Ollila DW, Stitzenberg KB, Meyers MO. Use of completion lymph node dissection for sentinel lymph node-positive melanoma. J Am Coll Surg. 2020;230(4):515–24.
doi: 10.1016/j.jamcollsurg.2019.12.010
Eggermont AM, Chiarion-Sileni V, Grob JJ, Dummer R, Wolchok JD, Schmidt H, et al. Adjuvant ipilimumab versus placebo after complete resection of high-risk stage III melanoma (EORTC 18071): a randomised, double-blind, phase 3 trial. Lancet Oncol. 2015;16(5):522–30.
doi: 10.1016/S1470-2045(15)70122-1
Long GV, Hauschild A, Santinami M, Atkinson V, Mandalà M, Chiarion-Sileni V, et al. Adjuvant dabrafenib plus trametinib in stage III BRAF-mutated melanoma. N Engl J Med. 2017;377(19):1813–23.
doi: 10.1056/NEJMoa1708539
Eggermont AMM, Blank CU, Mandala M, Long GV, Atkinson V, Dalle S, et al. Adjuvant pembrolizumab versus placebo in resected stage III melanoma. N Engl J Med. 2018;378(19):1789–801.
doi: 10.1056/NEJMoa1802357
Weber J, Mandala M, Del Vecchio M, Gogas HJ, Arance AM, Cowey CL, et al. Adjuvant nivolumab versus ipilimumab in resected stage III or IV melanoma. N Engl J Med. 2017;377(19):1824–35.
doi: 10.1056/NEJMoa1709030
Chapman BC, Gleisner A, Kwak JJ, Hosokawa P, Paniccia A, Merkow JS, et al. SPECT/CT improves detection of metastatic sentinel lymph nodes in Patients with head and neck melanoma. Ann Surg Oncol. 2016;23(8):2652–7.
doi: 10.1245/s10434-016-5175-6
Coit DG, Thompson JA, Albertini MR, Barker C, Carson WE, Contreras C, et al. Cutaneous melanoma, version 2.2019. NCCN Clin Pract Guidel Oncol. 2019;17(4):367.
Nijhuis AAG, Spillane AJ, Stretch JR, Saw RPM, Menzies AM, Uren RF, et al. Current management of patients with melanoma who are found to be sentinel node-positive. ANZ J Surg. 2020;90(4):491–6.
doi: 10.1111/ans.15491
Broman KK, Hughes T, Dossett L, Sun J, Kirichenko D, Carr MJ, et al. Active surveillance of patients who have sentinel node positive melanoma: an international, multi-institution evaluation of adoption and early outcomes after the multicenter selective lymphadenectomy Trial II (MSLT-2). Cancer. 2021;127(13):2251–61.
doi: 10.1002/cncr.33483
Broman KK, Hughes TM, Dossett LA, Sun J, Carr MJ, Kirichenko DA, et al. Surveillance of sentinel node-positive melanoma patients with reasons for exclusion from MSLT-II: multi-institutional propensity score matched analysis. J Am Coll Surg. 2021;232(4):424–31.
doi: 10.1016/j.jamcollsurg.2020.11.014
Farrow NE, Raman V, Williams TP, Nguyen KY, Tyler DS, Beasley GM. Adjuvant Therapy is effective for melanoma patients with a positive sentinel lymph node biopsy who forego completion lymphadenectomy. Ann Surg Oncol. 2020;27(13):5121–5.
doi: 10.1245/s10434-020-08478-7
Mitra D, Ologun G, Keung EZ, Goepfert RP, Amaria RN, Ross MI, et al. Nodal recurrence is a primary driver of early relapse for patients with sentinel lymph node-positive melanoma in the modern therapeutic Era. Ann Surg Oncol. 2021;28:3480–9.
doi: 10.1245/s10434-021-09804-3
van Akkooi ACJ, Nowecki ZI, Voit C, Schäfer-Hesterberg G, Michej W, de Wilt JHW, et al. Sentinel node tumor burden according to the Rotterdam criteria is the most important prognostic factor for survival in melanoma patients: a multicenter study in 388 patients with positive sentinel nodes. Ann Surg. 2008;248(6):949–55.
doi: 10.1097/SLA.0b013e31818fefe0
Keung EZ, Gershenwald JE. The eighth edition American Joint Committee on Cancer (AJCC) melanoma staging system: implications for melanoma treatment and care. Expert Rev Anticancer Ther. 2018;18(8):775–84.
doi: 10.1080/14737140.2018.1489246