Adjuvant radiation therapy for regional nodal metastases from malignant melanoma. A randomized, prospective study

Abstract

After nodal metastasis from malignant melanoma, approximately 80% of patients die from disseminated disease. To clarify the role of radiation therapy (XRT) following node dissection. 56 patients with biopsy-proven nodal metastasis participated in a randomized, prospective clinical trial which compares radiation therapy to the regional lymph node area following lymphadenectomy (27 patients) with lymphadenectomy alone (29 patients). Interesting differences in the survival curves (p = 0.09) and in the disease-free interval curves (p = 0.08) for the two treatment groups proved to be attributable to imbalances in the age and nodal distributions in the treatment groups. Covariate analysis identified age and sex as the factors having the most significant (p less than 0.04) effect on survival and identified the number of positive nodes as the covariate having the most significant (p less than 0.02) effect on disease-free interval. Treatment did not have a significant effect upon survival or disease-free interval.

Malignant Melanoma S3‐Guideline “Diagnosis, Therapy and Follow‐up of Melanoma”

“…Two randomized controlled trials [338,339] confirmed six retrospective cohort studies [336,337,340,341,343,345] in showing significantly higher locoregional control rates in patients with lymph node metastases undergoing postoperative adjuvant radiation therapy of the affected lymph node basins. In Burmeister et al, 34 of 127 patients without radiation therapy sustained locoregional lymph node recurrence, whereas in the patient group subjected to adjuvant radiation therapy, 20 patients suffered recurrence within the lymph node basin.…”

“…Systematic search of the literature de-novo: [336][337][338][339][340][341][342][343][344][345] Strength of consensus: 100%…”

“…Recurrence-free as well as overall survival, however, were not positively affected by adjuvant radiation therapy [338]. Creagean et al [339] reported prolongation of median recurrence-free survival by postoperative radiation therapy from 9 to 20 months. Although five cohort studies [336,337,341,343,345] corroborated the efficacy of postoperative radiation therapy, two different cohort studies and a case study revealed conflicting findings [342,344,346].…”

Melanoma During Pregnancy

“…Since such relapse is very difficult for treatment, there were attempts to obtain better results with postoperative radiotherapy. Although some phase II studies showed certain efficacy ), the only randomized study did not show any difference, neither in DFS, nor in OS (Creagan et al, 1978). Radiotherapy in metastatic melanoma is especially significant for symptoms palliation, primarely of pain due to bone metastases ).…”

“…Sinusal melanoma irradiation was proved useful and it is safe for the fetus. Adjuvant irradiation after lymphadenectomy proved no benefit in a randomized study (Creagan et al, 1978), so it should be avoided in pregnancy. A specific question is when to irradiate a pregnant patient with metastatic melanoma.…”