Department of Radiation Oncology, University of Florida College of Medicine, Gainesville, FL, USA.
Am J Otolaryngol. 2013 Jul-Aug;34(4):320-2. doi: 10.1016/j.amjoto.2012.12.014. Epub 2013 Jan 30.
To assess the efficacy of postoperative radiotherapy (RT) in the treatment of cutaneous melanoma.
Between August 1981 and December 2009, 82 patients were treated with surgery and postoperative RT for cutaneous melanoma. Patients were thought to be high risk for local-regional recurrence after surgery alone because of the presence of one or more risk factors including recurrence after prior surgery, positive lymph nodes, extracapsular extension, incomplete regional node dissection, microscopically positive margins, gross residual disease, and in-transit metastases. The primary site was located in the head and neck in 64 patients and elsewhere in the remainder. Forty-two patients (47%) were treated with hypofractionated RT and the remainder with conventional fractionation. Median age was 62 years (range, 21 to >89 years). Median follow-up overall and for survivors was 3.0 years (range, 0.1 to 17.4 years) and 6.4 years (1.6 to 17.4 years), respectively.
The 5-year outcomes were: in-field local-regional control 82%; local-regional control, 76%; distant metastasis-free survival, 48%; cause-specific survival, 56%; and overall survival, 43%. In-field local-regional control at 5 years was 87% after hypofractionated RT and 78% after conventionally fractionated RT.
Postoperative adjuvant RT likely reduces the risk of local-regional recurrence after surgery for patients with high risk cutaneous melanoma. Hypofractionated RT is as effective as conventional fractionation and is logistically advantageous, particularly for patients with a relatively poor prognosis. The risk of RT complications is low.
评估术后放疗（RT）在治疗皮肤黑色素瘤中的疗效。
1981 年 8 月至 2009 年 12 月期间，82 例皮肤黑色素瘤患者接受手术和术后 RT 治疗。由于存在一个或多个危险因素，如既往手术复发、淋巴结阳性、囊外扩展、区域淋巴结清扫不彻底、显微镜下切缘阳性、肉眼残留疾病和转移灶，这些患者术后单独手术存在局部区域复发的高风险。原发部位位于头颈部的 64 例，其余位于其他部位。42 例（47%）接受低分割 RT 治疗，其余接受常规分割。中位年龄为 62 岁（范围 21 至>89 岁）。总生存和幸存者的中位随访时间分别为 3.0 年（范围 0.1 至 17.4 年）和 6.4 年（1.6 至 17.4 年）。
5 年结果为：瘤床局部区域控制率为 82%；局部区域控制率为 76%；远处无转移生存率为 48%；特异性生存率为 56%；总生存率为 43%。低分割 RT 后 5 年的瘤床局部区域控制率为 87%，常规分割 RT 后为 78%。
对于高风险皮肤黑色素瘤患者，术后辅助 RT 可能降低手术局部区域复发的风险。低分割 RT 与常规分割一样有效，在后勤方面具有优势，特别是对于预后相对较差的患者。RT 并发症的风险较低。
