Some diagnoses, treatments, or procedures become closely identified with one or two people. Sentinel lymph node biopsy is a cancer-staging technique forever linked to Dr. Donald L. Morton, who in 1978 published his first findings on lymph node drainage and metastasis patterns in patients with malignant melanoma.
Since then, sentinel lymph node biopsy (SLNB) became the standard of care for staging a sizeable subset of patients with newly diagnosed melanoma, based largely on a prespecified interim analysis of data from the first Multicenter Selective Lymphadenectomy Trial (MSLT-I), a study with 2,001 patients launched by Dr. Morton and his associates in 1994 to definitively test the efficacy of SLNB.
Dr. Donald L. Morton
On Feb. 13, Dr. Morton and his associates published "the final trial report" from MSLT-I with 10-year follow-up, results that further confirmed the beneficial role of SLNB and brought full closure to a clinical journey that lasted nearly 40 years.
But Dr. Morton did not quite make it to see the article published. He died on Jan. 10 from heart failure, at age 79, at St. John’s Health Center in Santa Monica, Calif.
"Dr. Morton was incredibly pleased to know the paper was to be published. It was very gratifying to him that it was successfully completed and would be out in the New England Journal of Medicine," said Dr. Mark B. Faries, a senior collaborator with Dr. Morton on MSLT-I and director of melanoma research at the John Wayne Cancer Institute in Santa Monica, Calif.
Publication of the final report of the MSLT-I trial "is a capstone on Dr. Morton’s career," said Dr. Charles M. Balch, professor of surgery at the University of Texas Southwestern Medical Center at Dallas, in an interview. In an editorial accompanying the publication, Dr. Balch and a colleague wrote that the final report from the "landmark" MSLT-I trial "caps a 35-year effort to resolve the controversy surrounding the survival benefit of surgical excision of regional lymph nodes as a component of initial treatment of patients with primary melanoma."
Dr. Morton faced strong skepticism when he first presented his findings on the staging role for SLNB at a meeting in 1990 and in the years immediately after. His report describing a method for identifying and assessing sentinel lymph nodes was rejected by several "high-impact journals," recalled Dr. Balch and some of his colleagues in a remembrance that will be published in Annals of Surgical Oncology in March. "Undaunted, he persisted," they wrote, until the report appeared in Archives of Surgery in 1992. Designing, launching, and running MSLT-I came next, with many of the study’s major findings appearing in 2006. By confirming the efficacy of SLNB for staging many melanoma patients, MSLT-I was a "practice-changing trial," wrote Dr. Balch and his associates.
Although the new, 10-year follow-up gives closure to the central thesis of Dr. Morton’s SLNB technique, he didn’t stop there.
"Anyone who knew [Dr. Morton] would know he would never feel he had completed his work until the disease was cured for all," said Dr. Faries. "This is evidenced by the second MSLT trial that is now underway" that Dr. Morton and his associates launched to determine whether patients with positive sentinel lymph nodes benefit from the completion lymph node dissection that now follows as part of standard treatment. MSLT-II has randomized 1,900 patients so far, and the results are expected in a few years.
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