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Risk for nonsentinel node metastases increased with size of sentinel node metastasis
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Patients with vulvar cancer that has spread to the sentinel nodes are at greater risk for developing nonsentinel node metastases, according to results from a multicenter observational study.
From March 2000 to June 2006, 403 patients underwent excision of the primary tumor followed by the sentinel node procedure using radioactive tracer and blue dye.
One-third of patients (n=135) in the Groningen International Study on Sentinel Nodes in Vulvar Cancer (GROINSS-V) study had metastatic disease. Researchers found nonsentinel node metastases in 24 of those patients. Researchers said the risk for nonsentinel node metastases was greater when the sentinel node was found positive by routine histological assessment (23 of 85) vs. ultrastaging (3 of 56).
Survival was also closely associated with size of sentinel node metastases. Five-year disease-specific survival was 97% for patients with isolated tumor cells in the sentinel node compared with 88% for those with sentinel node metastases smaller than 2 mm, 70% for those with metastases from 2 mm to 5 mm and 69% for those with metastases larger than 5 mm.
“Nonsentinel node metastases occur more often as the size of sentinel node metastasis increases,” the researchers wrote. “Our analysis did not show a clear cut-off with respect to tumor load in the sentinel node below which no nonsentinel node metastases were observed. Therefore, all patients with sentinel node metastases require additional groin treatment.”
Writing in an accompanying editorial, Charles F. Levenback, MD, a professor in the department of gynecologic oncology at The University of Texas M.D. Anderson Cancer Center, said it was no surprise that the size of metastases was inversely proportional to survival. He also noted, however, that the number of metastases examined was small making confidence intervals very large.
“Since the safety of providing no further treatment in patients who had very small metastases could not be established, the investigators recommended additional treatment for patients with metastatic disease to a sentinel lymph node, even if the metastasis consists of isolated tumor cells,” Levenback wrote.
“They found that only 4.2% of patients with isolated tumor cells in a sentinel lymph node had metastases in nonsentinel lymph nodes, but the confidence interval is large (0.1%-21.1%). Unfortunately, this recommendation means that 79% to 99% of patients who receive lymphadenectomy or radiotherapy for isolated tumor cells in a sentinel lymph node biopsy will not benefit from the treatment.”
For more information:
- Oonk MH. Lancet Oncology. 2010:doi;10.1016/S1470-2045(10)70104-2.