Nodal basin recurrence following lymph node dissection for melanoma: implications for adjuvant radiotherapy

Lee, R.Jeffrey; Gibbs, John F.; Proulx, Gary M.; Kollmorgen, Daniel; Jia, Chaoying; Kraybill, William G.

doi:10.1016/s0360-3016(99)00431-9

Cited by 151 publications

(102 citation statements)

References 23 publications

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“…Also, all this variables were compared using survival curves and only male gender differed significantly with respect to survival. On the other hand, some authors identified male gender, primary tumour thickness, type of neck dissection (elective vs. therapeutic), ECE, and number and size of regional metastases, as statistically significant independent negative prognostic factors 21,26 .…”

Section: Discussionmentioning

confidence: 99%

Lymphatic drainage patterns of head and neck cutaneous melanoma: does primary melanoma site correlate with anatomic distribution of pathologically involved lymph nodes?

Suton¹,

Lukšić²,

Müller³

et al. 2012

International Journal of Oral and Maxillofacial Surgery

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Section: Discussionmentioning

confidence: 99%

Lymphatic drainage patterns of head and neck cutaneous melanoma: does primary melanoma site correlate with anatomic distribution of pathologically involved lymph nodes?

Suton¹,

Lukšić²,

Müller³

et al. 2012

International Journal of Oral and Maxillofacial Surgery

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“…With retrospective studies of adjuvant hypofractionated radiation therapy (RT) demonstrating a benefit in locoregional control in high‐risk non‐DM patients versus historical controls, as well as anecdotal and retrospective reports of good clinical results in high‐risk DM patients, a prospective phase II study was designed to determine if adjuvant hypofractionated RT would result in low LR rates in selected DM patients 9, 18, 19, 20, 21, 22, 23, 24, 25.…”

Section: Introductionmentioning

confidence: 99%

Results of NCCTG N0275 (Alliance) – a phase II trial evaluating resection followed by adjuvant radiation therapy for patients with desmoplastic melanoma

et al. 2016

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To examine, in a prospective fashion, the utilization and efficacy of adjuvant radiation therapy (RT) in patients with resected desmoplastic melanoma (DM). Adult patients with resected, margin‐negative, and nonmetastatic DM were eligible for this single‐arm prospective phase II study. Patients were to receive postoperative RT, 30 Gy in five fractions, to the operative bed with 2‐ to 3‐cm margins (depending on the tumor location). Nodal basin RT was not allowed. The primary study endpoint was the 2‐year local recurrence rate (LRR). Secondary endpoints included the incidence of regional and distant metastatic disease, progression‐free survival, overall survival (OS), and treatment‐related toxicity. Twenty patients with a single de novo DM lesion meeting trial eligibility criteria were enrolled and treated. The 2‐year LRR was 10%, with two patients demonstrating a LR within 2 years of completion of protocol therapy. No regional or distant failures occurred. OS at 2 and 5 years was 95 and 77%, respectively. There were no grade 3 or higher acute or late adverse events that were related to the protocol therapy. Adjuvant RT after wide local excision (WLE) for DM is efficacious and well tolerated. It should be considered for DM patients after margin‐negative WLE. Additional study is needed to further refine low‐risk patient populations that can potentially have adjuvant RT omitted as part of the treatment plan.

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“…Indeed, sSubsets known to be associated with local failure were not able to be evaluated with our dataset, including patient treated with nodal dissections after local recurrence, or patients with residual disease, large nodal metastases, or extracapsular extension. 6,[13][14][15][16] It is likely that some of these poor prognostic features are over-represented within the radiotherapy cohort in our study. This would explain why both the melanoma specific mortality and overall survival were worse; the patients who received radiotherapy had biologically more aggressive melanomas, which were more likely to have distant relapses and ultimately lead to the patients' deaths.…”

Section: Discussionmentioning

confidence: 88%

“…Given the pattern of spread of melanoma and the frequency of systemic microscopic disease, it is likely that improving locoregional control, whether with more extensive surgery or with postoperative radiotherapy, will only improve overall survival as more effective systemic therapies become available to treat microscopic distant disease in the adjuvant setting. 6,[13][14][15][16] Finally, another potential limitation is that the criteria for receiving, and details of radiotherapy are unknown. Multiple Phase II trials have utilized fraction sizes of 5 -6 Gy/fx (hypofractionation) instead of the conventional fraction size of 1.8-2.0 Gy per fraction 3,17 based on in vitro evidence.…”

Section: Discussionmentioning

confidence: 99%

A retrospective analysis of the role of adjuvant radiotherapy in the treatment of cutaneous melanoma

Baker

Camacho

Andrews

et al. 2016

Cancer Biology & Therapy

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Melanoma is a significant clinical problem, with rising rates of incidence. Surgery is the mainstay of treatment. The role of adjuvant radiotherapy in the control of locoregionally advanced cutaneous melanoma is controversial. A retrospective study of the Surveillance, Epidemiology, and End Results (SEER) database was performed. Patients with locoregionally confined cutaneous melanoma treated surgically between 2004 and 2009 were evaluated, with cancer-specific and all-cause mortality as primary end points. Propensity score matching was used to match 319 radiotherapy patients with 319 nonradiotherapy controls, stratifying by head and neck (HN) and non-head and neck (NHN) primary. Surgery was primarily by wide excision in both the radiotherapy (51.72%) and non-radiotherapy (53.91%) groups. The majority had nodal disease (82.13% vs. 82.44%). White (91.22% vs. 90.59%) males (70.21% vs. 68.96%) predominated. Average ages at diagnosis were 62.27 (SD 15.93) and 63.02 (SD 16.03). Using Cox proportional hazards models, radiation conferred decreased survival in all-cause (HR 1.44, p < 0.0003), and cancer specific mortality (HR 1.57, p < 0.0002) in combined analysis. The NHN group showed significantly decreased 6-year cancer specific survival (HR 2.05, p < 0.0001) for radiated patients. The HN group showed a non-significant hazard with radiotherapy (HR 1.19, p D 0.307). Meaningful differences not captured in the SEER database may exist between cohorts. Based on available SEER data, routine use of adjuvant radiotherapy should be viewed with caution and reserved for high-risk patients. Future trials evaluating patient quality of life may clarify the benefit of adjuvant radiotherapy in high-risk melanoma populations.

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Nodal basin recurrence following lymph node dissection for melanoma: implications for adjuvant radiotherapy

Cited by 151 publications

References 23 publications

Lymphatic drainage patterns of head and neck cutaneous melanoma: does primary melanoma site correlate with anatomic distribution of pathologically involved lymph nodes?

Lymphatic drainage patterns of head and neck cutaneous melanoma: does primary melanoma site correlate with anatomic distribution of pathologically involved lymph nodes?

Results of NCCTG N0275 (Alliance) – a phase II trial evaluating resection followed by adjuvant radiation therapy for patients with desmoplastic melanoma

A retrospective analysis of the role of adjuvant radiotherapy in the treatment of cutaneous melanoma

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