Melanoma Institute Australia, The University of Sydney, North Sydney, New South Wales, Australia.
Department of Surgical Oncology, University Medical Centre Groningen, Groningen, The Netherlands.
J Surg Oncol. 2023 Jul;128(1):97-104. doi: 10.1002/jso.27245. Epub 2023 Mar 27.
Adjuvant radiotherapy (RT) can be given to melanoma patients following salvage surgery for node field recurrence after a previous regional node dissection, but the value of this treatment strategy is poorly documented. This study evaluated long-term node field control and survival of patients treated in this way in an era before effective adjuvant systemic therapy became available.
Data for 76 patients treated between 1990 and 2011 were extracted from an institutional database. Baseline patient characteristics, treatment details and oncological outcomes were analysed.
Adjuvant RT with conventional fractionation (median dose 48 Gy in 20 fractions) was given to 43 patients (57%) and hypofractionated RT (median dose 33 Gy in 6 fractions) to 33 patients (43%). The 5-year node field control rate was 70%, 5-year recurrence-free survival 17%, 5-year melanoma-specific survival 26% and 5-year overall survival 25%.
Salvage surgery with adjuvant RT achieved node field control in 70% of melanoma patients with node field recurrence following a prior node dissection. However, disease progression at distant sites was common and survival outcomes were poor. Prospective data will be required to assess outcomes for contemporary combinations of surgery, adjuvant RT and systemic therapy.
在先前区域淋巴结清扫后出现淋巴结区域复发的情况下，辅助放疗（RT）可用于黑色素瘤患者的挽救性手术，但这种治疗策略的价值记录不佳。本研究评估了在有效辅助全身治疗可用之前的时代，以这种方式治疗的患者的长期淋巴结区域控制和生存情况。
从机构数据库中提取了 1990 年至 2011 年间治疗的 76 例患者的数据。分析了基线患者特征、治疗细节和肿瘤学结果。
43 例（57%）患者接受常规分割辅助 RT（中位剂量为 20 个分次的 48Gy），33 例（43%）患者接受低分割 RT（中位剂量为 6 个分次的 33Gy）。5 年淋巴结区域控制率为 70%，5 年无复发生存率为 17%，5 年黑色素瘤特异性生存率为 26%，5 年总生存率为 25%。
对于先前淋巴结清扫后出现淋巴结区域复发的黑色素瘤患者，挽救性手术联合辅助 RT 可实现淋巴结区域控制率为 70%。然而，远处部位的疾病进展很常见，生存结果较差。需要前瞻性数据来评估手术、辅助 RT 和全身治疗的当代联合治疗的结果。
