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Titolo:
Efficacy of lymphatic mapping, sentinel lymphadenectomy, and selective complete lymph node dissection as a therapeutic procedure for early-stage melanoma
Autore:
Essner, R; Conforti, A; Kelley, MC; Wanek, L; Stern, S; Glass, E; Morton, DL;
Indirizzi:
John Wayne Canc Inst, Roy E Coats Res Labs, Santa Monica, CA 90404 USA John Wayne Canc Inst Santa Monica CA USA 90404 Santa Monica, CA 90404 USA St Johns Hlth Ctr, Dept Nucl Med, Santa Monica, CA USA St Johns Hlth Ctr Santa Monica CA USA ept Nucl Med, Santa Monica, CA USA
Titolo Testata:
ANNALS OF SURGICAL ONCOLOGY
fascicolo: 5, volume: 6, anno: 1999,
pagine: 442 - 449
SICI:
1068-9265(199907/08)6:5<442:EOLMSL>2.0.ZU;2-6
Fonte:
ISI
Lingua:
ENG
Soggetto:
PRIMARY MALIGNANT-MELANOMA; CUTANEOUS MELANOMA; SURVIVAL; LYMPHOSCINTIGRAPHY; PROGRESSION; METASTASES; RECURRENCE; MANAGEMENT; DRAINAGE; BIOPSY;
Keywords:
malignant melanoma; lymph node dissection; sentinel lymph node; matched-pair analysis;
Tipo documento:
Article
Natura:
Periodico
Settore Disciplinare:
Clinical Medicine
Citazioni:
41
Recensione:
Indirizzi per estratti:
Indirizzo: Essner, R John Wayne Canc Inst, Roy E Coats Res Labs, 2200 Santa Monica Blvd, Santa Monica, CA 90404 USA John Wayne Canc Inst 2200 Santa Monica Blvd Santa Monica CA USA 90404
Citazione:
R. Essner et al., "Efficacy of lymphatic mapping, sentinel lymphadenectomy, and selective complete lymph node dissection as a therapeutic procedure for early-stage melanoma", ANN SURG O, 6(5), 1999, pp. 442-449

Abstract

Background: Lymphatic mapping, sentinel lymphadenectomy, and selective complete lymph node dissection (LM/SL/SCLND) is an increasingly popular alternative to elective lymphadenectomy (ELND) for patients with early-stage melanoma. Although several reports have demonstrated the accuracy of the LM/SL technique, there are no data on its therapeutic value. Methods: We performed a matched-pair statistical analysis of 534 patients with clinical stage I melanoma; one half of the patients were treated with LM/SL and the other half were treated with ELND. Patients in the two treatment groups were matched for age (54% were less than or equal to 50 years ofage), gender (63% were male patients), site of the primary melanoma (49% were on the extremities, 36% on the trunk, and 15% on the head and neck), and thickness of the primary melanoma (7% were <0.75 mm, 42% between 0.75 and1.5 mm, 43% between 1.51 and 4.0 mm, and 8% >4 mm). Patients in the LM/SL group underwent complete regional lymphadenectomy (SCLND) only if the LM/SLspecimen contained metastatic melanoma. Results: The overall incidences of nodal metastases were no different (P =.18) between LM/SL (15.7%) and ELND (12%) groups, but the incidence of occult nodal disease was significantly (P = .025) higher among patients with intermediate-thickness (1.51-4.0-mm) primary tumors who underwent LM/SL (23.7%) instead of ELND (12.2%). Survival data were compared by the log-rank score test. LM/SL/SCLND and ELND resulted in equivalent 5-year rates of disease-free survival (79 +/- 3.3% and 84 +/- 2.2%, respectively; P = .25) and overall survival (88 +/- 3.0% and 86 +/- 2.1%, respectively; P = .98). The LM/SL and ELND groups also exhibited similar incidences of same-basin recurrences (4.8% vs. 2.1%, P = .10, respectively) and in-transit metastases (2.6% vs. 3.8%, P = .48) after tumor-negative dissections. Patients who underwent ELND showed a higher incidence of distant recurrences (8.9% vs. 4.0%, P = .03), but this may be related to the longer follow-up period for these patients (median, 169 months), compared with the LM/SL-treated patients (45 months). Among patients with rumor-positive nodal dissections, the 5-year overall survival rates were higher, and approached significance (P = .077) for patients treated by LM/SL/SCLND (64 +/- 12%) compared with ELND (45 +/- 10%). Conclusions: These findings suggest that LM/SL/SCLND is therapeutically equivalent to ELND but may be more effective for identifying nodal metastasesin patients with intermediate-thickness primary tumors.

ASDD Area Sistemi Dipartimentali e Documentali, Università di Bologna, Catalogo delle riviste ed altri periodici
Documento generato il 05/12/20 alle ore 19:34:35