SENTINEL LYMPH NODE BIOPSY IN PREVENTING REGIONAL RELAPSES IN PATIENTS WITH LOCALLY ADVANCED CUTANEOUS MELANOMA

Abstract

Objective. To determine an optimal method for preventing regional relapses in patients with locally advanced cutaneous melanoma (CM).Material and methods. The investigation included 755 patients with locally advanced CM who had been treated at the Medical Radiology Research Centre. Among them, 213 patients had wide excision only for the primary tumor; 242 patients were additionally treated with preventive lymphadenectomy (pLAE), and 300 patients underwent sentinel lymph node (SLN) biopsy. The groups were matched for the local extent of a tumor in the TNM staging (p = 0.178), which allowed a proper comparative analysis of treatment results. The Russian radiopharmaceutical 99mTc-Technefit having necessary lymphotropic properties was used to identify SLN. Intraoperative navigation was performed using a Radical handheld gamma probe counter (Amplitude Research and Technology Center, Russia).Results. Regional relapses were observed in 20.2% of cases in the primary CM excision group. In the pLAE group, latent regional lymph node metastases were detected in 10.7% of the patients; and 12.0% more of the patients developed subsequently regional relapses in the intact lymph nodes. The total number of latent regional metastases in this group was 22.7%; these were diagnosed as a result of pLAE in less than half of the cases (47.3%). SLN biopsy revealed subclinical regional metastases in 20.7% of the patients and regional relapses were seen only in 3.3%. Overall, SLN biopsy could detect latent lymph node metastases in 86.1% of all cases; these were demonstrated with clinical relapses only in 13.9%. The efficiency of SLN biopsy in preventing regional relapses was significantly higher than was achievable during pLAE (p =0.001). The five and seven-year survival rates were 61.5 ± 4.3 and 54.3 ± 4.6% in the CM excision group, respectively; 68.8 ± 0.35 and 61.3±3.9% in the pLAE group; and 84.8 ± 6.5 and 84.8 ± 6.5% in the SLN biopsy group (p = 0.001).Conclusion. The investigation of SLN is the most effective, safe, and reproducible technique for the early detection of subclinical regional metastases and for the prevention of regional relapses in patients with locally advanced CM. Reliable regional control in turn makes it possible to hope for the best long-term treatment results.

Keywords

• sentinel lymph nodes
• cutaneous melanoma
• regional metastases
• metastases of melanoma
• regional relapses
• technefit