“Patients who receive the standard surgical treatment for melanoma that has spread to one or more key lymph nodes do not live longer, a major new study shows.
“The study, published today in The New England Journal of Medicine, found that immediately removing and performing biopsies on all lymph nodes located near the original tumor, a procedure called completion lymph node dissection, did not result in increased overall survival rates.”
“Experts have again come out in favor of the ‘less-is-more’ approach to breast cancer surgery and have endorsed previous recommendations not to automatically harvest all lymph nodes if cancer is found in a sentinel node, new guidelines from the American Society of Clinical Oncology (ASCO) indicate.
” ‘The standard of care used to be to take all lymph nodes, but the data have been quite compelling over the last few years, and now, it’s generally accepted that a complete lymph node dissection isn’t necessary for all patients,’ lead author Gary Lyman, MD, MPH, Fred Hutchinson Cancer Research Center, Seattle, Washington, said in a statement.
” ‘So if a woman has only one or two sentinel lymph nodes that are cancerous, and if the tumor is not too big and not too aggressive, there’s no value in doing a complete lymph node dissection,’ he added.”
“In a study reported in JAMA Oncology, Coromilas et al found that axillary lymph node evaluation is frequently performed in women with ductal carcinoma in situ (DCIS), and a number of hospital or surgeon characteristics are associated with likelihood of evaluation. As noted by the authors, benefit of axillary evaluation in this setting has not been demonstrated.
“The study involved cross-sectional analysis of medical records in the Perspective database for women with DCIS who underwent breast-conserving surgery or mastectomy from January 2006 to December 2012. A total of 35,591 women aged 18 to 90 years were included in the analysis.
“Overall, 9,011 women (25.3%) underwent mastectomy and 26,580 (74.7%) underwent breast-conserving surgery. Axillary evaluation was performed in 63.0% of those undergoing mastectomy and 17.7% of those undergoing breast-conserving surgery…
“The investigators concluded: ‘Despite guidelines recommending against axillary lymph node evaluation in women with DCIS undergoing [breast-conserving surgery] and uncertainty regarding its use with mastectomy, [sentinel lymph node biopsy] or [axillary lymph node dissection] is performed frequently. Given the additional morbidity and cost of these procedures, alternative surgical approaches or prospective evaluation of the clinical benefit of axillary evaluation in women with DCIS is needed.’ “
Jemal A, Simard EP ... Yankey D, Edwards BK. Journal of the National Cancer Institute. Jan. 7, 2013.
The Annual Report on the status of cancer shows a decline in cancer deaths from major cancers including lung, colorectal, prostate, and breast, but some cancer deaths continue to increase specifically for men with melanoma as well as for those with liver, uterine, and pancreatic cancers.
Flaherty, KT, Lee, SJ ... Leming, P, Kirkwood, JM. Journal of Clinical Oncology, Dec. 17, 2012.
Sorafenib plus chemotherapy did not improve the overall survival of metastatic melanoma patients not previously treated with chemotherapy. The trial results are published in the Journal of Clinical Oncology.