Combined-modality therapy for patients with regional nodal metastases from melanoma

Matthew T. Ballo, Merrick I. Ross, Janice N. Cormier, Jeffrey N. Myers, Jeffrey E. Lee, Jeffrey E. Gershenwald, Patrick Hwu, Gunar K. Zagars

Research output: Contribution to journalArticle

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Abstract

Purpose: To evaluate the outcome and patterns of failure for patients with nodal metastases from melanoma treated with combined-modality therapy. Methods and Materials: Between 1983 and 2003, 466 patients with nodal metastases from melanoma were managed with lymphadenectomy and radiation, with or without systemic therapy. Surgery was a therapeutic procedure for clinically apparent nodal disease in 434 patients (regionally advanced nodal disease). Adjuvant radiation was generally delivered with a hypofractionated regimen. Adjuvant systemic therapy was delivered to 154 patients. Results: With a median follow-up of 4.2 years, 252 patients relapsed and 203 patients died of progressive disease. The actuarial 5-year disease-specific, disease-free, and distant metastasis-free survival rates were 49%, 42%, and 44%, respectively. By multivariate analysis, increasing number of involved lymph nodes and primary ulceration were associated with an inferior 5-year actuarial disease-specific and distant metastasis-free survival. Also, the number of involved lymph nodes was associated with the development of brain metastases, whereas thickness was associated with lung metastases, and primary ulceration was associated with liver metastases. The actuarial 5-year regional (in-basin) control rate for all patients was 89%, and on multivariate analysis there were no patient or disease characteristics associated with inferior regional control. The risk of lymphedema was highest for those patients with groin lymph node metastases. Conclusions: Although regional nodal disease can be satisfactorily controlled with lymphadenectomy and radiation, the risk of distant metastases and melanoma death remains high. A management approach to these patients that accounts for the competing risks of distant metastases, regional failure, and long-term toxicity is needed.

Original languageEnglish (US)
Pages (from-to)106-113
Number of pages8
JournalInternational Journal of Radiation Oncology Biology Physics
Volume64
Issue number1
DOIs
StatePublished - Jan 1 2006

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Combined Modality Therapy
metastasis
Melanoma
therapy
Neoplasm Metastasis
lymphatic system
Lymph Nodes
Radiation
Lymph Node Excision
radiation
Multivariate Analysis
Lymphedema
Groin
liver
death
surgery
toxicity
lungs
brain
Therapeutics

All Science Journal Classification (ASJC) codes

  • Radiation
  • Oncology
  • Radiology Nuclear Medicine and imaging
  • Cancer Research

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Combined-modality therapy for patients with regional nodal metastases from melanoma. / Ballo, Matthew T.; Ross, Merrick I.; Cormier, Janice N.; Myers, Jeffrey N.; Lee, Jeffrey E.; Gershenwald, Jeffrey E.; Hwu, Patrick; Zagars, Gunar K.

In: International Journal of Radiation Oncology Biology Physics, Vol. 64, No. 1, 01.01.2006, p. 106-113.

Research output: Contribution to journalArticle

Ballo, Matthew T. ; Ross, Merrick I. ; Cormier, Janice N. ; Myers, Jeffrey N. ; Lee, Jeffrey E. ; Gershenwald, Jeffrey E. ; Hwu, Patrick ; Zagars, Gunar K. / Combined-modality therapy for patients with regional nodal metastases from melanoma. In: International Journal of Radiation Oncology Biology Physics. 2006 ; Vol. 64, No. 1. pp. 106-113.
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abstract = "Purpose: To evaluate the outcome and patterns of failure for patients with nodal metastases from melanoma treated with combined-modality therapy. Methods and Materials: Between 1983 and 2003, 466 patients with nodal metastases from melanoma were managed with lymphadenectomy and radiation, with or without systemic therapy. Surgery was a therapeutic procedure for clinically apparent nodal disease in 434 patients (regionally advanced nodal disease). Adjuvant radiation was generally delivered with a hypofractionated regimen. Adjuvant systemic therapy was delivered to 154 patients. Results: With a median follow-up of 4.2 years, 252 patients relapsed and 203 patients died of progressive disease. The actuarial 5-year disease-specific, disease-free, and distant metastasis-free survival rates were 49{\%}, 42{\%}, and 44{\%}, respectively. By multivariate analysis, increasing number of involved lymph nodes and primary ulceration were associated with an inferior 5-year actuarial disease-specific and distant metastasis-free survival. Also, the number of involved lymph nodes was associated with the development of brain metastases, whereas thickness was associated with lung metastases, and primary ulceration was associated with liver metastases. The actuarial 5-year regional (in-basin) control rate for all patients was 89{\%}, and on multivariate analysis there were no patient or disease characteristics associated with inferior regional control. The risk of lymphedema was highest for those patients with groin lymph node metastases. Conclusions: Although regional nodal disease can be satisfactorily controlled with lymphadenectomy and radiation, the risk of distant metastases and melanoma death remains high. A management approach to these patients that accounts for the competing risks of distant metastases, regional failure, and long-term toxicity is needed.",
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