Strom E A, Ross M I
Department of Radiotherapy, University of Texas M.D. Anderson Cancer Center, Houston 77030, USA.
Ann Surg Oncol. 1995 Sep;2(5):445-9. doi: 10.1007/BF02306379.
Certain patients with locally advanced melanoma have a high risk of regional recurrence after surgical excision and lymphadenectomy alone. Growing evidence suggests that radiation therapy may improve local control with acceptable morbidity for patients with melanoma in some sites. There is no information regarding the safety or efficacy of this treatment when applied to the axilla for regional metastasis of cutaneous melanoma.
We conducted a retrospective evaluation of patients who received postoperative radiation therapy to the axillary lymphatics for malignant melanoma at the M. D. Anderson Cancer Center between 1980 and 1992. Twenty-eight patients were identified who had undergone a formal axillary lymph node dissection followed by postoperative irradiation to the full axilla and supraclavicular fossa. Twenty-two patients were irradiated using a hypofractionated treatment regimen (4-7 Gy/fraction), generally to 30 Gy in five fractions.
Sixteen patients are currently alive. Actuarial survival at 5 years is 50.1%. Local tumor recurred or persisted in five patients, four of whom had clinically palpable tumor when they were irradiated.
Postoperative irradiation of the axilla for malignant melanoma has acceptable toxicity, even in those with extensive axillary dissection. In this group, patients treated for subclinical disease had a low rate of recurrence (1 of 21, [5%]).
某些局部晚期黑色素瘤患者在仅接受手术切除和淋巴结清扫后有较高的区域复发风险。越来越多的证据表明，放射治疗对于某些部位的黑色素瘤患者可能在可接受的发病率情况下改善局部控制。关于将这种治疗应用于皮肤黑色素瘤腋窝区域转移时的安全性或疗效尚无相关信息。
我们对1980年至1992年间在MD安德森癌症中心接受腋窝淋巴管术后放射治疗的恶性黑色素瘤患者进行了回顾性评估。确定了28例患者，他们接受了正式的腋窝淋巴结清扫，随后对整个腋窝和锁骨上窝进行术后照射。22例患者采用了大分割治疗方案（每次4 - 7 Gy），一般分五次照射至30 Gy。
16例患者目前仍存活。5年精算生存率为50.1%。5例患者出现局部肿瘤复发或持续存在，其中4例在接受照射时有临床可触及的肿瘤。
恶性黑色素瘤腋窝术后照射具有可接受的毒性，即使是那些接受广泛腋窝清扫的患者。在这组患者中，接受亚临床疾病治疗的患者复发率较低（21例中有1例，[5%]）。
