Study on melanoma spread in sentinel lymph nodes and survival

and….2016  (almost 1,200 patients):  http://chaoticallypreciselifeloveandmelanoma.blogspot.com/2016/08/sentinel-lymph-node-disection-important.html

There is much more if you put "sentinel" in search bubble on blog.  c

and….2016  (almost 1,200 patients):  http://chaoticallypreciselifeloveandmelanoma.blogspot.com/2016/08/sentinel-lymph-node-disection-important.html

There is much more if you put "sentinel" in search bubble on blog.  c

Hi Sole,

The short answer to your question is….I DID have a complete lymph node dissection….TWICE…with micro-mets in only one sentinel node on the first occasion.

The longer and possibly more important part to the answer is:  There were no addtional positive nodes within the roughly 30 additional nodes removed in both the CLNDs.  My first was done in 2003. The second in 2007.  Melanoma was a very different world then. There were NO valid treatment options should I progress. AND….I progressed to Stage IV in 2010 despite my surgeries.

While some of the older data (yes…it is older!) indicate there is a 10% overall survival improvement in folks who had a CLND. Now, as others have pointed out, OS is tricky to define because the studies are not good about explaining what, if anything, those folks did after having that CLND. Are they folks like me?  A person whose timeline could certainly have been counted in that group…but now has had 2 CLNDs AND 2 1/2 years of nivo? So, it all gets muddy quickly.

Most data, old and new, shows that a person with micro mets in the sentinel node, has only a 5-10% chance of ANY additional positive nodes if they were to have a CLND. Just as mine turned out….I had no additional positive nodes. Furthermore, while I was very lucky and have never had any problems with lymphedema…many have significant problems with that after a CLND. Many here on this forum deal with that issue daily. It is tough. They are incredible, do what they have to do, and go on with their lives, but it is nothing to just disregard!

The reality of your situation is that you would most likely have no have additional positive nodes found if you do go forward with a CLND. But…noone can tell you that for sure. The reality is that your are most likely never going to deal with melanoma again in your life….that's what the data shows. There is no reason to think that you would follow in my footsteps. Additionally, should you progress….with or without a CLND….you have treatment options! Good ones. Those were not something available to me when I had to make my decisions.

But here is the bottom line. If you feel you cannot let this go, move forward and live your life, without incessant worry over not having done it…do the CLND…and then more on. Decisions in melanoma are intensely personal. All I can advise anyone is….educate yourself, attain an evaluation by at least one (or more) melanoma specialist, then make what you think is the best decision for YOU…and never look back.

I wish you well.  Les

Hi Sole,

The short answer to your question is….I DID have a complete lymph node dissection….TWICE…with micro-mets in only one sentinel node on the first occasion.

The longer and possibly more important part to the answer is:  There were no addtional positive nodes within the roughly 30 additional nodes removed in both the CLNDs.  My first was done in 2003. The second in 2007.  Melanoma was a very different world then. There were NO valid treatment options should I progress. AND….I progressed to Stage IV in 2010 despite my surgeries.

While some of the older data (yes…it is older!) indicate there is a 10% overall survival improvement in folks who had a CLND. Now, as others have pointed out, OS is tricky to define because the studies are not good about explaining what, if anything, those folks did after having that CLND. Are they folks like me?  A person whose timeline could certainly have been counted in that group…but now has had 2 CLNDs AND 2 1/2 years of nivo? So, it all gets muddy quickly.

Most data, old and new, shows that a person with micro mets in the sentinel node, has only a 5-10% chance of ANY additional positive nodes if they were to have a CLND. Just as mine turned out….I had no additional positive nodes. Furthermore, while I was very lucky and have never had any problems with lymphedema…many have significant problems with that after a CLND. Many here on this forum deal with that issue daily. It is tough. They are incredible, do what they have to do, and go on with their lives, but it is nothing to just disregard!

The reality of your situation is that you would most likely have no have additional positive nodes found if you do go forward with a CLND. But…noone can tell you that for sure. The reality is that your are most likely never going to deal with melanoma again in your life….that's what the data shows. There is no reason to think that you would follow in my footsteps. Additionally, should you progress….with or without a CLND….you have treatment options! Good ones. Those were not something available to me when I had to make my decisions.

But here is the bottom line. If you feel you cannot let this go, move forward and live your life, without incessant worry over not having done it…do the CLND…and then more on. Decisions in melanoma are intensely personal. All I can advise anyone is….educate yourself, attain an evaluation by at least one (or more) melanoma specialist, then make what you think is the best decision for YOU…and never look back.

I wish you well.  Les

Hi Sole,

The short answer to your question is….I DID have a complete lymph node dissection….TWICE…with micro-mets in only one sentinel node on the first occasion.

The longer and possibly more important part to the answer is:  There were no addtional positive nodes within the roughly 30 additional nodes removed in both the CLNDs.  My first was done in 2003. The second in 2007.  Melanoma was a very different world then. There were NO valid treatment options should I progress. AND….I progressed to Stage IV in 2010 despite my surgeries.

While some of the older data (yes…it is older!) indicate there is a 10% overall survival improvement in folks who had a CLND. Now, as others have pointed out, OS is tricky to define because the studies are not good about explaining what, if anything, those folks did after having that CLND. Are they folks like me?  A person whose timeline could certainly have been counted in that group…but now has had 2 CLNDs AND 2 1/2 years of nivo? So, it all gets muddy quickly.

Most data, old and new, shows that a person with micro mets in the sentinel node, has only a 5-10% chance of ANY additional positive nodes if they were to have a CLND. Just as mine turned out….I had no additional positive nodes. Furthermore, while I was very lucky and have never had any problems with lymphedema…many have significant problems with that after a CLND. Many here on this forum deal with that issue daily. It is tough. They are incredible, do what they have to do, and go on with their lives, but it is nothing to just disregard!

The reality of your situation is that you would most likely have no have additional positive nodes found if you do go forward with a CLND. But…noone can tell you that for sure. The reality is that your are most likely never going to deal with melanoma again in your life….that's what the data shows. There is no reason to think that you would follow in my footsteps. Additionally, should you progress….with or without a CLND….you have treatment options! Good ones. Those were not something available to me when I had to make my decisions.

But here is the bottom line. If you feel you cannot let this go, move forward and live your life, without incessant worry over not having done it…do the CLND…and then more on. Decisions in melanoma are intensely personal. All I can advise anyone is….educate yourself, attain an evaluation by at least one (or more) melanoma specialist, then make what you think is the best decision for YOU…and never look back.

I wish you well.  Les

and….2016  (almost 1,200 patients):  http://chaoticallypreciselifeloveandmelanoma.blogspot.com/2016/08/sentinel-lymph-node-disection-important.html

There is much more if you put "sentinel" in search bubble on blog.  c

You do understand that all stats are out of date.  With 5 or 6 new treatments in the last 5 years, that's a game changer on statistics.  Just a reminder….

You do understand that all stats are out of date.  With 5 or 6 new treatments in the last 5 years, that's a game changer on statistics.  Just a reminder….

A valid admonishment, anon. But you might consider the point I made below. C

A valid admonishment, anon. But you might consider the point I made below. C

A valid admonishment, anon. But you might consider the point I made below. C

You do understand that all stats are out of date.  With 5 or 6 new treatments in the last 5 years, that's a game changer on statistics.  Just a reminder….

Join the crowd.  So grateful for her input.

Join the crowd.  So grateful for her input.

Hey John and anon,

Thanks for the shout out. John, you made me laugh out loud…not sure if you're appreciating the articles, my strange blog commentary, or irreverance in general! Anyhow, I really do appreciate the positive reinforcement. Love ya back! C, les, and B

Hey John and anon,

Thanks for the shout out. John, you made me laugh out loud…not sure if you're appreciating the articles, my strange blog commentary, or irreverance in general! Anyhow, I really do appreciate the positive reinforcement. Love ya back! C, les, and B

Hey John and anon,

Thanks for the shout out. John, you made me laugh out loud…not sure if you're appreciating the articles, my strange blog commentary, or irreverance in general! Anyhow, I really do appreciate the positive reinforcement. Love ya back! C, les, and B

Join the crowd.  So grateful for her input.

Ed is exactly right regarding checking reports carefully for who precisely was examined in the study and WHEN!  Studies that are only 2 years old can be light years behind in melanoma, given the advances that have been made in treatments just since 2011.  However, given how little adjuvant care is availabke for NED patients, especially for Stage III folks, discussions re sentinel node studies and progression remain important over a greater period of time than those dealing with treatment options for Stage IV/Stage III with active and/inoperable disease. 

Love you, Edster! C

Ed is exactly right regarding checking reports carefully for who precisely was examined in the study and WHEN!  Studies that are only 2 years old can be light years behind in melanoma, given the advances that have been made in treatments just since 2011.  However, given how little adjuvant care is availabke for NED patients, especially for Stage III folks, discussions re sentinel node studies and progression remain important over a greater period of time than those dealing with treatment options for Stage IV/Stage III with active and/inoperable disease. 

Love you, Edster! C

Ed is exactly right regarding checking reports carefully for who precisely was examined in the study and WHEN!  Studies that are only 2 years old can be light years behind in melanoma, given the advances that have been made in treatments just since 2011.  However, given how little adjuvant care is availabke for NED patients, especially for Stage III folks, discussions re sentinel node studies and progression remain important over a greater period of time than those dealing with treatment options for Stage IV/Stage III with active and/inoperable disease. 

Love you, Edster! C

Sole,

I fear you are never going to find the answers you are seeking. But, just sticking to the question of OS and RFS per stage…you are unlikely to find a perfect printout of each stage and prognosis that is up-to-date, adressing every caveat and treatment option.

This report is probably one of the most recent, published this year, tallying 3,554 melanoma patients from 2005 to 2012….and even it still has some of the problems discussed in this thread:  http://onlinelibrary.wiley.com/doi/10.1002/ijc.30407/abstract

At this point, to learn melanoma stats you have to look at individual studies.  The one I posted on my blog on October 14, 2016 – "Prolonged survival in Stage III melanoma treated with ipi as adjuvant" – is a good example.  You can find the data  you seek within studies if you read carefully and the comparison arm was matched to the control arm and it is clear that the control arm is given no additional treatment other than that which is clearly described. (Can only give you 2 links per post on this board, so you'll have to look back yourself if you want to see it.)

For instance, in the study I posted, you can see the numbers for Stage III patients who were treated with ipi as adjuvant vs those who were not. All had their initial melanoma removed at the start. Half got ipi, half got nothing else…and the outcome is reported.  And even here….what was the breakdown per Stage III a, b, or c? I don't know for sure.  It was most likely Stage IIIc patients. The full article may have that info or you can try to look at the study description at clinicaltrials.gov.

I think this is the study the article is discussing:   https://clinicaltrials.gov/ct2/show/NCT00636168?term=Phase+3+trial+with+ipilimumab+adjuvant+stage+III+melanoma&rank=1

So…given how melanoma land works these days, with new treatments available beyond trials just since 2011, and the necessary delay between treatment and data (which is much longer when looking at adjuvant treatment as there is no measureable disease handy for ready and rapid comparison) this is about the only way to determine hard cold numbers. However, many on this board, as well as melanoma specialists, are well versed in the current realities of melanoma and have much data available and a well tuned gestalt. 

Hope that helps with your search. C

Sole,

I fear you are never going to find the answers you are seeking. But, just sticking to the question of OS and RFS per stage…you are unlikely to find a perfect printout of each stage and prognosis that is up-to-date, adressing every caveat and treatment option.

This report is probably one of the most recent, published this year, tallying 3,554 melanoma patients from 2005 to 2012….and even it still has some of the problems discussed in this thread:  http://onlinelibrary.wiley.com/doi/10.1002/ijc.30407/abstract

At this point, to learn melanoma stats you have to look at individual studies.  The one I posted on my blog on October 14, 2016 – "Prolonged survival in Stage III melanoma treated with ipi as adjuvant" – is a good example.  You can find the data  you seek within studies if you read carefully and the comparison arm was matched to the control arm and it is clear that the control arm is given no additional treatment other than that which is clearly described. (Can only give you 2 links per post on this board, so you'll have to look back yourself if you want to see it.)

For instance, in the study I posted, you can see the numbers for Stage III patients who were treated with ipi as adjuvant vs those who were not. All had their initial melanoma removed at the start. Half got ipi, half got nothing else…and the outcome is reported.  And even here….what was the breakdown per Stage III a, b, or c? I don't know for sure.  It was most likely Stage IIIc patients. The full article may have that info or you can try to look at the study description at clinicaltrials.gov.

I think this is the study the article is discussing:   https://clinicaltrials.gov/ct2/show/NCT00636168?term=Phase+3+trial+with+ipilimumab+adjuvant+stage+III+melanoma&rank=1

So…given how melanoma land works these days, with new treatments available beyond trials just since 2011, and the necessary delay between treatment and data (which is much longer when looking at adjuvant treatment as there is no measureable disease handy for ready and rapid comparison) this is about the only way to determine hard cold numbers. However, many on this board, as well as melanoma specialists, are well versed in the current realities of melanoma and have much data available and a well tuned gestalt. 

Hope that helps with your search. C

Sole,

I fear you are never going to find the answers you are seeking. But, just sticking to the question of OS and RFS per stage…you are unlikely to find a perfect printout of each stage and prognosis that is up-to-date, adressing every caveat and treatment option.

This report is probably one of the most recent, published this year, tallying 3,554 melanoma patients from 2005 to 2012….and even it still has some of the problems discussed in this thread:  http://onlinelibrary.wiley.com/doi/10.1002/ijc.30407/abstract

At this point, to learn melanoma stats you have to look at individual studies.  The one I posted on my blog on October 14, 2016 – "Prolonged survival in Stage III melanoma treated with ipi as adjuvant" – is a good example.  You can find the data  you seek within studies if you read carefully and the comparison arm was matched to the control arm and it is clear that the control arm is given no additional treatment other than that which is clearly described. (Can only give you 2 links per post on this board, so you'll have to look back yourself if you want to see it.)

For instance, in the study I posted, you can see the numbers for Stage III patients who were treated with ipi as adjuvant vs those who were not. All had their initial melanoma removed at the start. Half got ipi, half got nothing else…and the outcome is reported.  And even here….what was the breakdown per Stage III a, b, or c? I don't know for sure.  It was most likely Stage IIIc patients. The full article may have that info or you can try to look at the study description at clinicaltrials.gov.

I think this is the study the article is discussing:   https://clinicaltrials.gov/ct2/show/NCT00636168?term=Phase+3+trial+with+ipilimumab+adjuvant+stage+III+melanoma&rank=1

So…given how melanoma land works these days, with new treatments available beyond trials just since 2011, and the necessary delay between treatment and data (which is much longer when looking at adjuvant treatment as there is no measureable disease handy for ready and rapid comparison) this is about the only way to determine hard cold numbers. However, many on this board, as well as melanoma specialists, are well versed in the current realities of melanoma and have much data available and a well tuned gestalt. 

Hope that helps with your search. C