Adjuvant radiotherapy significantly improved regional lymphatic control for high-risk patients after therapeutic lymphadenectomy for metastatic melanoma, according to the results of a study published in the Lancet Oncology.
Of the more than one million new diagnoses of skin cancer each year, roughly 68,000 involve melanoma. More than 8,000 people die of melanoma each year in the United States. What makes melanoma so dangerous is that it is more likely than other types of skin cancer to spread (metastasize) to other parts of the body. Historically, the use of radiation therapy in melanoma has been controversial; however, researchers continue to evaluate new and more effective approaches for managing the disease—including radiation.
Researchers conducted a randomized clinical trial in 16 hospitals in Australia, New Zealand, the Netherlands, and Brazil to evaluate the use of radiation therapy in melanoma. The study included 217 patients who had undergone therapeutic lymphadenectomy for metastatic melanoma in regional lymph nodes. All patients were at high risk of lymph-node field relapse. Patients were randomized to receive adjuvant radiotherapy of 48 Gy in 20 fractions (109 patients) or observation (108 patients).
After a median follow-up of 40 months, the researchers found that the risk of lymph-node field relapse was significantly reduced in the patients receiving adjuvant radiation therapy compared to their counterparts in the observation group. There were 20 relapses in the radiotherapy group, compared to 34 in the observation group. Although there was a significant improvement in the risk of local relapse within the affected nodal basins, there were no differences in relapse-free survival or overall survival. Side effects were generally mild. The most common grade 3 and 4 adverse events were seroma, radiation dermatitis, and wound infection.
The researchers concluded that adjuvant radiation therapy improves lymph-node field control in patients at high risk of lymph-node field relapse after therapeutic lymphadenectomy for metastatic melanoma. Risk stratification measures, such as the number and size of involved nodes and the presence of extracapsular disease, might be used to identify patients at high risk of regional lymphatic failure.
Burmeister BH, Henderson MA, Ainslie J, et al. Adjuvant radiotherapy versus observation alone for patients at risk of lymph-node field relapse after therapeutic lymphadenectomy for melanoma: a randomised trial. The Lancet Oncology. 2012; 13(6): 589-597.
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