Sentences with phrase «nodal recurrence»

[6] In the MSLT - 1 trial, patients with isolated nodal recurrence had more total lymph nodes involved by melanoma than patients randomized to SLN biopsy who had a positive biopsy (all of whom were to have CLND; an average of 3.2 lymph nodes involved with metastatic melanoma vs only 1.4 positive nodes, respectively; P <.0001), [2] and were more likely to meet established criteria for adjuvant radiation, [7] which further increases the risk of postoperative lymphedema.

The MSLT - 1 trial demonstrated that patients with a positive SLN undergoing CLND had far better melanoma - specific survival than those patients who manifested nodal recurrence either on the observation arm or after a false - negative SLN biopsy (10 - year melanoma - specific survival rates: 62.1 % vs 41.5 % and 34.4 %, respectively).

Furthermore, SLN - positive patients who defer lymphadenectomy until clinically detected nodal recurrence may present with unresectable disease, representing a missed opportunity for regional disease control.

Importantly, when eventual nodal recurrence makes delayed lymphadenectomy necessary, the procedure is actually associated with considerably higher morbidity than would have occurred had CLND been done promptly after SLN biopsy.

The rationale for an observational approach is to avoid the morbidity of lymphadenectomy (specifically to avoid the possibility of lymphedema) for two subsets of patients who never manifest isolated recurrence in the lymph node basin: those who have no melanoma remaining in the nodal basin and those who experience distant treatment failure at or before the time of nodal recurrence.

Not exact matches

Patients with nodal metastases should receive special attention, since this was found to be the only independent predictor of recurrence.

However, it is clear that nodal basin recurrence can occur years or even decades after initial surgery, [2] so patients who choose nodal observation are committed to long - term follow - up of uncertain value.