Ingo Stoffels1,2,3, Ken Herrmann4, Jan Rekowski5, Philipp Jansen1,2,3, Dirk Schadendorf1,2,3, Andreas Stang5, Joachim Klode6,7,8. 1. Department of Dermatology, Venerology and Allergology, University-Hospital Essen, University of Duisburg-Essen, 45122, Essen, Germany. 2. West German Cancer Center, University Duisburg-Essen, 45122, Essen, Germany. 3. German Consortium for Translational Cancer Research, Partner Site University Hospital Essen, Essen, Germany. 4. Center of Clinical Epidemiology, Institute of Medical Informatics, Biometry and Epidemiology (IMIBE), University Hospital Essen, 45122, Essen, Germany. 5. Department of Nuclear Medicine, University of Essen-Duisburg, 45122, Essen, Germany. 6. Department of Dermatology, Venerology and Allergology, University-Hospital Essen, University of Duisburg-Essen, 45122, Essen, Germany. joachim.klode@uk-essen.de. 7. West German Cancer Center, University Duisburg-Essen, 45122, Essen, Germany. joachim.klode@uk-essen.de. 8. German Consortium for Translational Cancer Research, Partner Site University Hospital Essen, Essen, Germany. joachim.klode@uk-essen.de.
Abstract
BACKGROUND: Melanoma has become a growing interdisciplinary problem in public health worldwide. According to the World Health Organization, the incidence of melanoma is increasing faster than any other cancer in the world. Because melanoma metastasizes early into the regional lymph nodes, sentinel lymph node excision (SLNE) is included in the current American Joint Committee of Cancer guidelines. However SLNE of melanoma has a high false-negative rate of up to 44%. METHODS: The gold standard for detection and extirpation of the sentinel lymph node is preoperative lymphoscintigraphy. SPECT/CT provides complementary information: the advantages include accurate anatomical localization, identification of false positives, reduction in the number of false negatives, and alteration of the surgical approach. Therefore, sentinel lymph node-SPECT/CT provides valuable information before sentinel lymph node excision and advocates its use in melanoma. We present a multicenter, unblinded superiority randomized controlled trial to compare SPECT/CT-aided SLNE versus standard SLNE in melanoma patients. DISCUSSION: The primary efficacy endpoint is distant metastasis-free survival. Secondary endpoints comprise overall survival, disease-free survival, rate of local relapses within the follow-up period (false-negative rate of sentinel lymph node), number of positive sentinel lymph nodes (sensitivity, false-positive rate), complication rate, quality of life, quality-adjusted life years, inpatient days, and overall costs during hospital stays. TRIAL REGISTRATION: ClinicalTrials.gov, NCT03683550 . Registered on 20 September 2018.
RCT Entities:
BACKGROUND:Melanoma has become a growing interdisciplinary problem in public health worldwide. According to the World Health Organization, the incidence of melanoma is increasing faster than any other cancer in the world. Because melanoma metastasizes early into the regional lymph nodes, sentinel lymph node excision (SLNE) is included in the current American Joint Committee of Cancer guidelines. However SLNE of melanoma has a high false-negative rate of up to 44%. METHODS: The gold standard for detection and extirpation of the sentinel lymph node is preoperative lymphoscintigraphy. SPECT/CT provides complementary information: the advantages include accurate anatomical localization, identification of false positives, reduction in the number of false negatives, and alteration of the surgical approach. Therefore, sentinel lymph node-SPECT/CT provides valuable information before sentinel lymph node excision and advocates its use in melanoma. We present a multicenter, unblinded superiority randomized controlled trial to compare SPECT/CT-aided SLNE versus standard SLNE in melanomapatients. DISCUSSION: The primary efficacy endpoint is distant metastasis-free survival. Secondary endpoints comprise overall survival, disease-free survival, rate of local relapses within the follow-up period (false-negative rate of sentinel lymph node), number of positive sentinel lymph nodes (sensitivity, false-positive rate), complication rate, quality of life, quality-adjusted life years, inpatient days, and overall costs during hospital stays. TRIAL REGISTRATION: ClinicalTrials.gov, NCT03683550 . Registered on 20 September 2018.
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