Department of Surgical Oncology, Roswell Park Cancer Institute, State University of New York, Buffalo, New York 14263, USA.
Cancer. 2009 Dec 15;115(24):5836-44. doi: 10.1002/cncr.24627.
The objective of this study was to evaluate the impact of adjuvant radiation therapy (RT) on regional recurrence and survival after therapeutic lymphadenectomy (TL) for clinically advanced, lymph node-metastatic melanoma.
Six hundred fifteen patients who had clinically advanced, regional lymph node-metastatic disease underwent TL. All patients were appropriate potential candidates for adjuvant RT (enlarged or multiple positive lymph nodes, extracapsular extension) because of a high risk for regional recurrence regardless of whether or not they received RT. Patient-related, tumor-related, and treatment-related variables that were associated with recurrence, survival, and treatment-related morbidity with and without RT were analyzed.
The median follow-up was 5 years. The actuarial 5-year regional lymph node basin control rate was 81%. On multivariate analysis, the number of positive lymph nodes, the number of lymph nodes removed, and the use of adjuvant RT were associated with improved regional control. Treatment-related morbidity, particularly lymphedema, was increased with the use of adjuvant RT and an inguinal site of lymph node metastases. At last follow-up, 268 patients were alive with actuarial 5-year distant metastasis-free survival (DMFS) and disease-specific survival (DSS) rates of 40% and 48%, respectively. On multivariate analysis, DMFS and DSS both were influenced by the number of positive lymph nodes and the number of lymph nodes removed. In addition, DSS was influenced by primary tumor thickness and the receipt of adjuvant RT.
Adjuvant RT was associated with improved regional lymph node basin control compared with TL alone in patients with high-risk, clinically advanced, lymph node-metastatic melanoma. Although it is a regional therapy, adjuvant RT also may have an impact on DSS.
本研究旨在评估辅助放疗（RT）对治疗性淋巴结清扫术（TL）治疗临床晚期淋巴结转移性黑色素瘤后的区域复发和生存的影响。
615 例临床晚期区域淋巴结转移性疾病患者接受 TL。所有患者均为辅助 RT 的合适潜在候选者（淋巴结肿大或多个阳性、囊外扩展），因为无论是否接受 RT，区域复发风险均较高。分析与 RT 相关和不相关的患者相关、肿瘤相关和治疗相关变量与复发、生存和治疗相关发病率的关系。
中位随访时间为 5 年。5 年区域淋巴结盆控制率的估计值为 81%。多变量分析显示，阳性淋巴结数量、切除的淋巴结数量和辅助 RT 的使用与改善区域控制相关。治疗相关发病率，特别是淋巴水肿，随着辅助 RT 和腹股沟淋巴结转移部位的使用而增加。末次随访时，268 例患者存活，无远处转移生存（DMFS）和疾病特异性生存（DSS）的估计 5 年率分别为 40%和 48%。多变量分析显示，DMFS 和 DSS 均受阳性淋巴结数量和切除淋巴结数量的影响。此外，DSS 还受原发肿瘤厚度和辅助 RT 治疗的影响。
与单独 TL 相比，辅助 RT 可改善高危、临床晚期淋巴结转移性黑色素瘤患者的区域淋巴结盆控制。尽管它是一种局部治疗，但辅助 RT 也可能对 DSS 有影响。
