A critical assessment of adjuvant radiotherapy for inguinal lymph node metastases from melanoma

被引:47
作者
Ballo, MT
Zagars, GK
Gershenwald, JE
Lee, JE
Mansfield, PF
Kim, KB
Camacho, LH
Hwu, P
Ross, MI
机构
[1] Univ Texas, MD Anderson Canc Ctr, Dept Radiat Oncol, Houston, TX 77030 USA
[2] Univ Texas, MD Anderson Canc Ctr, Dept Surg Oncol, Houston, TX 77030 USA
[3] Univ Texas, MD Anderson Canc Ctr, Houston, TX 77030 USA
[4] Univ Texas, MD Anderson Canc Ctr, Dept Melanoma Med Oncol, Houston, TX 77030 USA
关键词
lymph nodes; melanoma; radiation;
D O I
10.1245/ASO.2004.12.039
中图分类号
R73 [肿瘤学];
学科分类号
100214 ;
摘要
Background: Although patients with inguinal or pelvic lymph node (LN) metastases from melanoma may develop regional recurrence after dissection, the role of adjuvant radiotherapy remains controversial. Methods: The medical records of 40 patients with inguinal and/or pelvic lymph node metastases from melanoma were reviewed retrospectively. Indications for adjuvant radiotherapy included the following nodal characteristics: extracapsular extension, LNs greater than or equal to3 cm in diameter, greater than or equal to4 involved LNs, and LN recurrence after prior nodal surgery. Thirty-seven of 40 patients underwent formal LN dissection. Three patients had only local excision of gross disease for recurrence after prior dissection. All patients received radiation to a median dose of 30 Gy at six Gy/fraction delivered twice weekly. Results: With a median follow-up time of 22.5 months, the 3-year actuarial distant metastasis-free and overall survival rates were 35% and 38%, respectively. The 3-year regional control rate was 74%. Univariate analyses of patient, tumor, and treatment characteristics failed to reveal any association with distant metastasis-free survival, overall survival, or regional control. Regional failures occurred in nine patients; seven of these were isolated dermal failures within the field of irradiation. Only two patients (5%) had LN basin recurrences; one of these patients also developed dermal recurrence. Fifteen of 40 patients developed lymphedema; in seven of these, lymphedema was present before initiation of radiation therapy. Conclusions: Radiation may prevent recurrence of nodal disease in patients at high risk for regional failure, but in-field dermal recurrences may sometimes occur (8 of 40, 20%). Treatment-related lymphedema and death from metastatic melanoma were common.
引用
收藏
页码:1079 / 1084
页数:6
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