Sondak V K
Division of Surgical Oncology, University of Michigan Medical School, Ann Arbor, USA.
Cancer J. 2001 Jul-Aug;7 Suppl 1:S24-7.
Patients with deep primaries (> or = 4 mm) or regional lymph node involvement often require adjuvant therapy in addition to surgery to successfully treat melanoma. Various adjuvant strategies are reviewed. Randomized trials of IFN-alpha adjuvant therapy have demonstrated statistically significant improvements in disease-free and overall survival rates, leading to approval by the United States Food and Drug Administration of the use of 1 year of intensive IFN-alpha2b following surgical resection of high-risk disease. A study comparing high-dose IFN with the ganglioside vaccine GMK was terminated early when the Data Safety Monitoring Committee concluded that the high-dose IFN treatment arm was associated with highly significantly improved relapse-free and overall survival. Studies of IFN-alpha in stage I and II melanoma are reviewed. Dose and schedule issues in the use of IFN-alpha are addressed. In addition to adjuvant therapy with IFN-alpha, various other treatment strategies appear promising. Adjuvant vaccine therapy may be useful for treatment of cutaneous melanoma. Polyvalent melanoma vaccines are discussed as a potential adjuvant therapy. Finally, nonrandomized preliminary studies suggest that postoperative radiation to the neck or axilla after radical lymph node dissection may decrease regional recurrence rates in node-positive patients, supporting the selective use of radiation therapy for melanoma.
原发灶较深（≥4毫米）或有区域淋巴结受累的黑色素瘤患者，除手术外往往还需要辅助治疗才能成功治愈。本文综述了各种辅助治疗策略。α干扰素辅助治疗的随机试验已证明，无病生存率和总生存率有统计学意义的显著提高，这使得美国食品药品监督管理局批准了在高危疾病手术切除后使用1年强化α干扰素2b的治疗方案。一项比较高剂量α干扰素与神经节苷脂疫苗GMK的研究提前终止，当时数据安全监测委员会得出结论，高剂量α干扰素治疗组的无复发生存率和总生存率有极显著提高。本文综述了α干扰素在Ⅰ期和Ⅱ期黑色素瘤中的研究。文中还讨论了α干扰素使用中的剂量和疗程问题。除了α干扰素辅助治疗外，其他各种治疗策略似乎也很有前景。辅助疫苗治疗可能对皮肤黑色素瘤的治疗有用。本文讨论了多价黑色素瘤疫苗作为一种潜在的辅助治疗方法。最后，非随机的初步研究表明，根治性淋巴结清扫术后对颈部或腋窝进行术后放疗可能会降低淋巴结阳性患者的区域复发率，这支持了黑色素瘤选择性使用放疗的观点。
