Beadle Beth M, Guadagnolo B Ashleigh, Ballo Matthew T, Lee Jeffrey E, Gershenwald Jeffrey E, Cormier Janice N, Mansfield Paul F, Ross Merrick I, Zagars Gunar K
Department of Radiation Oncology, The University of Texas M. D. Anderson Cancer Center, Houston, TX 77030, USA.
Int J Radiat Oncol Biol Phys. 2009 Apr 1;73(5):1376-82. doi: 10.1016/j.ijrobp.2008.06.1910. Epub 2008 Sep 5.
To compare treatment-related outcomes and toxicity for patients with axillary lymph node metastases from malignant melanoma treated with postoperative radiation therapy (RT) to either the axilla only or both the axilla and supraclavicular fossa (extended field [EF]).
The medical records of 200 consecutive patients treated with postoperative RT for axillary lymph node metastases from malignant melanoma were retrospectively reviewed. All patients received postoperative hypofractionated RT for high-risk features; 95 patients (48%) received RT to the axilla only and 105 patients (52%) to the EF.
At a median follow-up of 59 months, 111 patients (56%) had sustained relapse, and 99 patients (50%) had died. The 5-year overall survival, disease-free survival, and distant metastasis-free survival rates were 51%, 43%, and 46%, respectively. The 5-year axillary control rate was 88%. There was no difference in axillary control rates on the basis of the treated field (89% for axilla only vs. 86% for EF; p = 0.4). Forty-seven patients (24%) developed treatment-related complications. On both univariate and multivariate analyses, only treatment with EF irradiation was significantly associated with increased treatment-related complications.
Adjuvant hypofractionated RT to the axilla only for metastatic malignant melanoma with high-risk features is an effective method to control axillary disease. Limiting the radiation field to the axilla only produced equivalent axillary control rates to EF and resulted in lower treatment-related complication rates.
比较接受术后放射治疗（RT）的恶性黑色素瘤腋窝淋巴结转移患者，仅对腋窝或腋窝及锁骨上窝（扩大野[EF]）进行治疗的相关治疗结局和毒性反应。
回顾性分析200例接受术后RT治疗恶性黑色素瘤腋窝淋巴结转移的连续患者的病历。所有患者因高危特征接受术后大分割RT；95例（48%）患者仅接受腋窝RT，105例（52%）患者接受EF RT。
中位随访59个月时，111例（56%）患者出现持续复发，99例（50%）患者死亡。5年总生存率、无病生存率和无远处转移生存率分别为51%、43%和46%。5年腋窝控制率为88%。根据治疗野不同，腋窝控制率无差异（仅腋窝为89%，EF为86%；p = 0.4）。47例（24%）患者出现治疗相关并发症。单因素和多因素分析均显示，仅EF照射治疗与治疗相关并发症增加显著相关。
对于具有高危特征的转移性恶性黑色素瘤，仅对腋窝进行辅助大分割RT是控制腋窝疾病的有效方法。仅将放射野局限于腋窝可产生与EF相当的腋窝控制率，并导致较低的治疗相关并发症发生率。
