Adjuvant radiotherapy following neck dissection and parotidectomy for metastatic malignant melanoma

Abstract

Background Regional recurrence remains a problem in the management of patients with metastatic malignant melanoma in the cervical lymph nodes and parotid. In this study, the influence of the number of positive nodes, extracapsular spread, and the use of adjuvant radiotherapy on regional control and survival were analyzed. Methods A non‐randomized, prospectively documented series of 143 patients with histologically positive nodes in the neck or parotid was analyzed. There were 152 dissected necks or parotids: 45 of these received postoperative radiotherapy, 6 × 5.5 Gy fractions over 3 weeks; 107 were not irradiated. Results The regional recurrence rate was 6.5% in the irradiated group, compared with 18.7% in the non‐irradiated group (p = .055). The irradiated group, however, had more extensive nodal involvement than the non‐irradiated group: 65% had two or more positive nodes, and 48% had extracapsular spread, compared with 40% and 19%, respectively, in the non‐irradiated group. Survival was significantly worse when there was extracapsular spread (p < .05) or multiple node involvement (p < .01). By multivariate analysis, the use of adjuvant radiotherapy was associated with a trend toward improved regional control (p = .065), but survival was not improved. Conclusions Adjuvant radiotherapy was associated with improved control of metastatic malignant melanoma in the neck and parotid; however, statistical significance was not reached. A prospective trial should be supported to clarify this question. © 1997 John Wiley & Sons, Inc. Head Neck 19: 589–594, 1997.

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%…”

“…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]. Due to methodological flaws, however, the validity of these studies is diminished.…”

Management of Head and Neck Melanoma

“…Firstly we were able to show a significant reduction in recurrence in patients who received adjuvant radiation, especially those with N3 disease. O'Brien (O'Brien et al, 1997) was also able to demonstrate a reduction in recurrence but this fell short of statistical significance (just). Our overall rerecurrence rate of 28% in patients who did not receive adjuvant radiation is similar to the figure reported by O'Brien et al (O'Brien et al, 1997) and lower than many reports (O'brien et al, 1997).…”

“…O'Brien (O'Brien et al, 1997) was also able to demonstrate a reduction in recurrence but this fell short of statistical significance (just). Our overall rerecurrence rate of 28% in patients who did not receive adjuvant radiation is similar to the figure reported by O'Brien et al (O'Brien et al, 1997) and lower than many reports (O'brien et al, 1997). The dramatic decrease in recurrence in our patient both with N3 disease and regional disease overall is in agreement with the findings of Ang and colleagues (Ang et al, 1994) from the MD Anderson unit in Texas.…”