Adjuvant irradiation for cervical lymph node metastases from melanoma

Matthew Ballo, Mark D. Bonnen, Adam S. Garden, Jeffrey N. Myers, Jeffrey E. Gershenwald, Gunar K. Zagars, Naomi R. Schechter, William H. Morrison, Merrick I. Ross, K. Kian Ang

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Abstract

BACKGROUND. The risk of regional disease recurrence after surgery alone for lymph node metastases from melanoma is well documented. The role of adjuvant irradiation remains controversial. METHODS. The medical records of 160 patients with cervical lymph node metastases from melanoma were reviewed retrospectively. Of these, 148 (93%) presented with clinically palpable lymph node metastases. All patients underwent surgery and radiation to a median dose of 30 grays (Gy) at 6 Gy per fraction delivered twice weekly. Surgical resection was either a selective neck dissection in 90 patients or local excision of the lymph node metastasis in 35 patients. Only 35 patients underwent a radical, modified radical, or functional neck dissection. RESULTS. At a median follow-up of 78 months, the actuarial local, regional, and locoregional control rates at 10 years were 94%, 94%, and 91%, respectively. Univariate analysis of patient, tumor, and treatment characteristics failed to reveal any association with the subsequent rate of local or regional control. The actuarial disease-specific (DSS), disease-free, and distant metastasis-free survival (DMFS) rates at 10 years were 48%, 42%, and 43%, respectively. Univariate and multivariate analyses revealed that patients with four or more involved lymph nodes had a significantly worse DSS and DMFS. Nine patients developed a treatment-related complication requiring medical management, resulting in a 5-year actuarial complication-free survival rate of 90%. CONCLUSIONS. Adjuvant radiotherapy resulted in a 10-year regional control rate of 94%. Complications for all patients were rare and manageable when they did occur. The authors recommend adjuvant irradiation for patients with extracapsular extension, lymph nodes measuring 3 cm in size or larger, the involvement of multiple lymph nodes, recurrent disease, or any patient having undergone a selective therapeutic neck dissection.

Original languageEnglish (US)
Pages (from-to)1789-1796
Number of pages8
JournalCancer
Volume97
Issue number7
DOIs
StatePublished - Apr 1 2003

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Melanoma
Lymph Nodes
Neoplasm Metastasis
Neck Dissection
Survival Rate
Adjuvant Radiotherapy
Lymph Node Excision
Medical Records
Therapeutics
Multivariate Analysis
Radiation
Recurrence
Survival

All Science Journal Classification (ASJC) codes

  • Oncology
  • Cancer Research

Cite this

Ballo, M., Bonnen, M. D., Garden, A. S., Myers, J. N., Gershenwald, J. E., Zagars, G. K., ... Ang, K. K. (2003). Adjuvant irradiation for cervical lymph node metastases from melanoma. Cancer, 97(7), 1789-1796. https://doi.org/10.1002/cncr.11243

Adjuvant irradiation for cervical lymph node metastases from melanoma. / Ballo, Matthew; Bonnen, Mark D.; Garden, Adam S.; Myers, Jeffrey N.; Gershenwald, Jeffrey E.; Zagars, Gunar K.; Schechter, Naomi R.; Morrison, William H.; Ross, Merrick I.; Ang, K. Kian.

In: Cancer, Vol. 97, No. 7, 01.04.2003, p. 1789-1796.

Research output: Contribution to journalArticle

Ballo, M, Bonnen, MD, Garden, AS, Myers, JN, Gershenwald, JE, Zagars, GK, Schechter, NR, Morrison, WH, Ross, MI & Ang, KK 2003, 'Adjuvant irradiation for cervical lymph node metastases from melanoma', Cancer, vol. 97, no. 7, pp. 1789-1796. https://doi.org/10.1002/cncr.11243
Ballo M, Bonnen MD, Garden AS, Myers JN, Gershenwald JE, Zagars GK et al. Adjuvant irradiation for cervical lymph node metastases from melanoma. Cancer. 2003 Apr 1;97(7):1789-1796. https://doi.org/10.1002/cncr.11243
Ballo, Matthew ; Bonnen, Mark D. ; Garden, Adam S. ; Myers, Jeffrey N. ; Gershenwald, Jeffrey E. ; Zagars, Gunar K. ; Schechter, Naomi R. ; Morrison, William H. ; Ross, Merrick I. ; Ang, K. Kian. / Adjuvant irradiation for cervical lymph node metastases from melanoma. In: Cancer. 2003 ; Vol. 97, No. 7. pp. 1789-1796.
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abstract = "BACKGROUND. The risk of regional disease recurrence after surgery alone for lymph node metastases from melanoma is well documented. The role of adjuvant irradiation remains controversial. METHODS. The medical records of 160 patients with cervical lymph node metastases from melanoma were reviewed retrospectively. Of these, 148 (93{\%}) presented with clinically palpable lymph node metastases. All patients underwent surgery and radiation to a median dose of 30 grays (Gy) at 6 Gy per fraction delivered twice weekly. Surgical resection was either a selective neck dissection in 90 patients or local excision of the lymph node metastasis in 35 patients. Only 35 patients underwent a radical, modified radical, or functional neck dissection. RESULTS. At a median follow-up of 78 months, the actuarial local, regional, and locoregional control rates at 10 years were 94{\%}, 94{\%}, and 91{\%}, respectively. Univariate analysis of patient, tumor, and treatment characteristics failed to reveal any association with the subsequent rate of local or regional control. The actuarial disease-specific (DSS), disease-free, and distant metastasis-free survival (DMFS) rates at 10 years were 48{\%}, 42{\%}, and 43{\%}, respectively. Univariate and multivariate analyses revealed that patients with four or more involved lymph nodes had a significantly worse DSS and DMFS. Nine patients developed a treatment-related complication requiring medical management, resulting in a 5-year actuarial complication-free survival rate of 90{\%}. CONCLUSIONS. Adjuvant radiotherapy resulted in a 10-year regional control rate of 94{\%}. Complications for all patients were rare and manageable when they did occur. The authors recommend adjuvant irradiation for patients with extracapsular extension, lymph nodes measuring 3 cm in size or larger, the involvement of multiple lymph nodes, recurrent disease, or any patient having undergone a selective therapeutic neck dissection.",
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AU - Bonnen, Mark D.

AU - Garden, Adam S.

AU - Myers, Jeffrey N.

AU - Gershenwald, Jeffrey E.

AU - Zagars, Gunar K.

AU - Schechter, Naomi R.

AU - Morrison, William H.

AU - Ross, Merrick I.

AU - Ang, K. Kian

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N2 - BACKGROUND. The risk of regional disease recurrence after surgery alone for lymph node metastases from melanoma is well documented. The role of adjuvant irradiation remains controversial. METHODS. The medical records of 160 patients with cervical lymph node metastases from melanoma were reviewed retrospectively. Of these, 148 (93%) presented with clinically palpable lymph node metastases. All patients underwent surgery and radiation to a median dose of 30 grays (Gy) at 6 Gy per fraction delivered twice weekly. Surgical resection was either a selective neck dissection in 90 patients or local excision of the lymph node metastasis in 35 patients. Only 35 patients underwent a radical, modified radical, or functional neck dissection. RESULTS. At a median follow-up of 78 months, the actuarial local, regional, and locoregional control rates at 10 years were 94%, 94%, and 91%, respectively. Univariate analysis of patient, tumor, and treatment characteristics failed to reveal any association with the subsequent rate of local or regional control. The actuarial disease-specific (DSS), disease-free, and distant metastasis-free survival (DMFS) rates at 10 years were 48%, 42%, and 43%, respectively. Univariate and multivariate analyses revealed that patients with four or more involved lymph nodes had a significantly worse DSS and DMFS. Nine patients developed a treatment-related complication requiring medical management, resulting in a 5-year actuarial complication-free survival rate of 90%. CONCLUSIONS. Adjuvant radiotherapy resulted in a 10-year regional control rate of 94%. Complications for all patients were rare and manageable when they did occur. The authors recommend adjuvant irradiation for patients with extracapsular extension, lymph nodes measuring 3 cm in size or larger, the involvement of multiple lymph nodes, recurrent disease, or any patient having undergone a selective therapeutic neck dissection.

AB - BACKGROUND. The risk of regional disease recurrence after surgery alone for lymph node metastases from melanoma is well documented. The role of adjuvant irradiation remains controversial. METHODS. The medical records of 160 patients with cervical lymph node metastases from melanoma were reviewed retrospectively. Of these, 148 (93%) presented with clinically palpable lymph node metastases. All patients underwent surgery and radiation to a median dose of 30 grays (Gy) at 6 Gy per fraction delivered twice weekly. Surgical resection was either a selective neck dissection in 90 patients or local excision of the lymph node metastasis in 35 patients. Only 35 patients underwent a radical, modified radical, or functional neck dissection. RESULTS. At a median follow-up of 78 months, the actuarial local, regional, and locoregional control rates at 10 years were 94%, 94%, and 91%, respectively. Univariate analysis of patient, tumor, and treatment characteristics failed to reveal any association with the subsequent rate of local or regional control. The actuarial disease-specific (DSS), disease-free, and distant metastasis-free survival (DMFS) rates at 10 years were 48%, 42%, and 43%, respectively. Univariate and multivariate analyses revealed that patients with four or more involved lymph nodes had a significantly worse DSS and DMFS. Nine patients developed a treatment-related complication requiring medical management, resulting in a 5-year actuarial complication-free survival rate of 90%. CONCLUSIONS. Adjuvant radiotherapy resulted in a 10-year regional control rate of 94%. Complications for all patients were rare and manageable when they did occur. The authors recommend adjuvant irradiation for patients with extracapsular extension, lymph nodes measuring 3 cm in size or larger, the involvement of multiple lymph nodes, recurrent disease, or any patient having undergone a selective therapeutic neck dissection.

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