Melanoma staging by biopsy leads to better long-term survival
Melanoma staging by biopsy leads to better long-term survival
12/2/2014
Intermediate & thick melanomas staged by biopsy were associated with better 10-year disease and metastasis-free survival, compared to wide excision and nodal observation. This was shown in the final results of a randomized trial.
A strategy of sentinel node biopsy followed by lymphadenectomy as indicated was associated with a 24% improvement in disease-free survival for patients with intermediate-thickness melanomas and a 30% increase for patients with thick lesions.
Biopsy-driven management was associated with 38% and 44% improvement in distant disease-free survival (DFS) and melanoma-specific survival at 10 years for patients with intermediate-thickness melanomas and nodal metastases, as reported online in the New England Journal of Medicine.
"These long-term results clearly validate the use of sentinel-node biopsy in patients with intermediate-thickness or thick primary melanomas," Mark Faries, MD, of John Wayne Cancer Institute in Santa Monica, Calif., and co-authors concluded.
"The procedure provides accurate and important staging information, enhances regional disease control, and, among patients with nodal metastases, appears to improve melanoma-specific survival substantially."
The findings and conclusions came from a final analysis of the Multicenter Selective Lymphadenectomy Trial, which involved 2,100 patients with primary cutaneous melanomas. Investigators randomized the patients to wide excision and nodal observation or to excision, sentinel node biopsy, and immediate lymphadenectomy for patients with nodal spread.
The 5-year results showed a survival benefit for biopsy-based staging in patients with intermediate-thickness melanomas (1.2 to 3.5 mm). The 10-year results extended improvement in DFS to patients with thick lesions (>3.5 mm).
After 10 years of follow-up, DFS was 71.3% with sentinel node biopsy and 64.7% in patients with intermediate-thickness melanomas and 50.7% versus 40.5% for patients with thicker melanomas.
The authors of an accompanying editorial called the study practice changing. The results showed that biopsy-based management provides important staging information and improves survival in defined patient cohorts, said Charles M. Balch, MD, of the University of Texas Southwestern Medical Center in Dallas, and Jeffrey E. Gershenwald, MD, of the University of Texas MD Anderson Cancer Center in Houston.
Source: MedPage Today: http://www.medpagetoday.com/HematologyOncology/OtherCancers/44279