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Is Complete Lymph Node Dissection of Benefit for Some Patients With Melanoma?

By: Lauren Harrison, MS
Posted: Friday, October 11, 2019

The final analysis of the phase III German Dermatologic Cooperative Oncology Group trial at 72 months showed similar results to the 3-year analysis, confirming that immediate complete lymph node dissection in patients with sentinel lymph node–positive melanoma is not superior to observation. Ulrike Leiter, MD, of Eberhard Karls University of Tübingen, Germany, and colleagues reported these results in the Journal of Clinical Oncology.

“Therapeutic benefit for complete lymph node dissection could not be demonstrated.... [T]herefore, the recommendation of complete lymph node dissection has to be discussed with caution, especially as new, promising adjuvant treatment modalities are available,” concluded the authors.

This trial recruited patients with cutaneous melanoma of the trunk and extremities to be randomly assigned to receive either cervical lymph node dissection or observation. The trial spanned from January 2006 to December 2014 and recruited 5,547 patients. A total of 1,256 patients were identified to have sentinel lymph node involvement, and 483 patients with sentinel metastasis were included in the study. The observation arm had 241 patients, and 242 patients underwent complete lymph node dissection.

At a median follow-up of 72 months, there was no significant treatment-related difference seen in the 5-year distant metastasis–free survival between the two treatment arms (67.6% with observation and 64.9% with lymph node dissection, hazard ratio = 1.08). The 5-year recurrence-free survival and overall survival rates again showed no difference between these two treatments. However, patients who underwent lymph node dissection had more adverse events. Grade 3 and 4 adverse events occurred in 32% of patients who underwent lymph node dissection, with lymphedema (20 patients) and delayed wound healing (5 patients) being the most common. There were no serious adverse events reported.

Disclosure: The study authors’ disclosure information can be found at ascopubs.org.



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