高危III期黑色素瘤区域淋巴结清扫术后的大分割或常规分割辅助放疗
Hypofractionated or Conventionally Fractionated Adjuvant Radiotherapy After Regional Lymph Node Dissection for High-Risk Stage III Melanoma.
作者信息
Holtkamp L H J, Lo S, Drummond M, Thompson J F, Nieweg O E, Hong A M
机构信息
Melanoma Institute Australia, The University of Sydney, Sydney, NSW, Australia; Department of Surgical Oncology, University Medical Centre Groningen, Groningen, the Netherlands.
Melanoma Institute Australia, The University of Sydney, Sydney, NSW, Australia; Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia.
出版信息
Clin Oncol (R Coll Radiol). 2023 Jan;35(1):e85-e93. doi: 10.1016/j.clon.2022.06.012. Epub 2022 Jul 16.
AIMS
Adjuvant radiotherapy can be beneficial after regional lymph node dissection for high-risk stage III melanoma, as it has been shown to reduce the risk of recurrence in the node field. However, the optimal fractionation schedule is unknown and both hypofractionated and conventionally fractionated adjuvant radiotherapy are used. The present study examined the oncological outcomes of these two approaches in patients treated in an era before effective systemic immunotherapy became available.
MATERIALS AND METHODS
This retrospective cohort study involved 335 patients with stage III melanoma who received adjuvant radiotherapy after therapeutic regional lymph node dissection for metastatic melanoma between 1990 and 2011. Information on tumour characteristics, radiotherapy doses and fractionation schedules and patient outcomes was retrieved from the institution's database and patients' medical records.
RESULTS
Hypofractionated radiotherapy (median dose 33 Gy in six fractions over 3 weeks) was given to 95 patients (28%) and conventionally fractionated radiotherapy (median dose 48 Gy in 20 fractions over 4 weeks) to 240 patients (72%). Five-year lymph node field control rates were 86.0% (95% confidence interval 78.4-94.4%) for the hypofractionated group and 85.5% (95% confidence interval 80.5-90.7%) for the conventional fractionation group (P = 0.87). There were no significant differences in recurrence-free survival (RFS) (41.7%, 95% confidence interval 32.5-53.5 versus 31.9%, 95% confidence interval 26.1-38.9; P = 0.18) or overall survival (41.2%, 95% confidence interval 32.1-52.8 versus 45.0%, 95% confidence interval 38.7-52.4; P = 0.77). On multivariate analysis, extranodal spread was associated with decreased RFS (P = 0.04) and the number of resected lymph nodes containing metastatic melanoma was associated with decreased RFS (P = 0.0006) and overall survival (P = 0.01).
CONCLUSION
Lymph node field control rates, RFS and overall survival were similar after hypofractionated and conventionally fractionated adjuvant radiotherapy. The presence of extranodal spread and an increasing number of positive lymph nodes were predictive of an unfavourable outcome.
目的
对于高危III期黑色素瘤患者，区域淋巴结清扫术后辅助放疗可能有益，因为已证明其可降低淋巴结区域的复发风险。然而，最佳分割方案尚不清楚，目前低分割和常规分割的辅助放疗均在使用。本研究在有效全身免疫治疗出现之前的时代，考察了这两种方法在接受治疗的患者中的肿瘤学结局。
材料与方法
这项回顾性队列研究纳入了335例III期黑色素瘤患者，这些患者在1990年至2011年间因转移性黑色素瘤接受治疗性区域淋巴结清扫术后接受了辅助放疗。从机构数据库和患者病历中检索肿瘤特征、放疗剂量、分割方案及患者结局等信息。
结果
95例患者（28%）接受了低分割放疗（中位剂量33 Gy，分6次，3周内完成），240例患者（72%）接受了常规分割放疗（中位剂量48 Gy，分20次，4周内完成）。低分割组的5年淋巴结区域控制率为86.0%（95%置信区间78.4 - 94.4%），常规分割组为85.5%（95%置信区间80.5 - 90.7%）（P = 0.87）。无复发生存期（RFS）（41.7%，95%置信区间32.5 - 53.5%对31.9%，95%置信区间26.1 - 38.9%；P = 0.18）或总生存期（41.2%，95%置信区间32.1 - 52.8%对45.0%，95%置信区间38.7 - 52.4%；P = 0.77）无显著差异。多因素分析显示，结外扩散与RFS降低相关（P = 0.04），切除的含有转移性黑色素瘤的淋巴结数量与RFS降低相关（P = 0.0006）及总生存期降低相关（P = 0.01）。
结论
低分割和常规分割辅助放疗后的淋巴结区域控制率、RFS和总生存期相似。结外扩散的存在及阳性淋巴结数量增加提示预后不良。
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