Multicenter Selective Lymphadenectomy Trial 2 (MSLT-2)

  • The Multicenter Selective Lymphadenectomy Trial 2 (MSLT-2):
    • Was recently published in June 2017:
      • Which evaluated completion lymphadenectomy versus observation following positive sentinel lymph node biopsies for metastatic melanoma
    • There was no significant difference:
      • In disease-specific survival among the two treatment groups
    • Key limitations to the study were:
      • That it mostly included patients with a low burden of disease (% nodal involvement, largest metastatic focus, and number of positive nodes) in their sentinel lymph nodes
      • The study has limited median follow-up:
        • 43 months
      • Furthermore, it is important to note that there was a significant difference in disease-free survival between groups and that subjects in the study did not receive contemporary systemic therapy
    • Debate remains for which subset of patients would benefit most from completion lymphadenectomy:
      • However, it is reasonable for most of these patients to be observed closely with:
        • Nodal ultrasounds:
          • Every 4 months for the first 2 years
          • Every 6 months for years 3 to 5
          • Then annually.
  • References:
    • Faries MB, Thompson JF, Cochran AJ, et al. Completion Dissection or Observation for Sentinel-Node Metastasis in Melanoma. N Engl J Med. 2017; 376(23): 2211-2222.

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