Lymphadenectomy after a positive sentinel node biopsy in patients with cutaneous melanoma. A systematic review

Maribel L Da Cunha Cosme,Juan F Liuzzi Samaterra,José I Chaviano Hernández,Saul A Siso Cardenas

doi:10.1186/s42047-020-00083-y

Maribel L Da Cunha Cosme, Juan F Liuzzi Samaterra + Show 2 more

Open Access

https://doi.org/10.1186/s42047-020-00083-y

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Abstract

Complete lymph node dissection (CLND) following a positive sentinel lymph node biopsy (SLNB) has been the standard treatment for years. However, there is increasing evidence that CLND could be omitted. Approximately 80% of patients with a positive sentinel node biopsy do not have additional nodal involvement; in these contexts, the SLNB could be diagnostic and therapeutic. However, in this group of patients, the therapeutic effect of CLND is unclear.A systematic search was performed in EMBASE and MEDLINE (PubMed), for studies published between January 1, 2014 and December 31, 2019. Studies were included when they compared immediate CLND and observation after a positive sentinel node. The outcomes of interest were: Overall Survival (OS), melanoma-specific survival (MSS), and disease-free survival (DFS).Eleven studies met the inclusion criteria. Two randomized clinical trials reported no differences in OS or MSS when complete lymph dissection was compared with observation alone. An increase in regional relapse was observed in the CLND group, and in one randomized controlled trial (RCT) the rate of disease-free survival was superior in those patients.Most populations in both RCTs had low sentinel lymph node biopsy (SLNB) metastatic deposits, and head and neck melanomas were not included or underrepresented. When CNLD was omitted, an active surveillance protocol was carried out.The evidence supports that CLND in SLNB positive patients does not confer a survival benefit. Sentinel tumor burden, localization of primary tumor, and feasibility of active surveillance should be taken into account in treatment decisions.

Highlights

The incidence of cutaneous melanoma has been increasing over the recent decades and, currently, more than 130,000 cases occur globally each year (WHO, 2019)
We identified two randomized controlled trial (RCT) in which, following surgical excision of the primary cutaneous melanoma, Complete lymph node dissection (CLND) was compared with observation (Faries et al, 2017; Leiter et al, 2019), the remaining studies were observational and retrospective (Bamboat et al, 2014; Satzger et al, 2014; van der Ploeg et al, 2014; Melstrom et al, 2014; Gyorki et al, 2014; Fritsch et al, 2016; Mosquera et al, 2017; Lee et al, 2016; Klemen et al, 2019)
DeCOG-SLT was stopped prematurely due to recruiting problems, and the study finished under powered

Summary

Introduction

The incidence of cutaneous melanoma has been increasing over the recent decades and, currently, more than 130,000 cases occur globally each year (WHO, 2019). Surgery represents the mainstay of melanoma treatment; for regional disease, sentinel lymph node biopsy (SLNB) is recommended for patients with Breslow depth > 1 mm and for patients with thinner melanomas and negative pathological features (Wong et al, 2018). The Multicenter Selective Lymphadenectomy Trial I (MSLT-I) demonstrated that sentinel node status is the most important prognostic factor for survival in patients with localized disease, and positive SLNB followed with CLND might improve the disease-free survival (Morton et al, 2014). Approximately 80% of patients with a positive sentinel node biopsy do not have additional nodal involvement, in these contexts the SLNB could be diagnostic and therapeutic. In this group of patients, the therapeutic effect of CLND is unclear (Morton et al, 2014)

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