title: Adjuvant radiotherapy following neck dissection and parotidectomy for metastatic malignant melanoma.
abstract: BACKGROUND
  Regional recurrence remains a problem in the management of patients with metastatic malignant melanoma in the cervical lymph nodes and parotid. In this study, the influence of the number of positive nodes, extracapsular spread, and the use of adjuvant radiotherapy on regional control and survival were analyzed.
  
  
  METHODS
  A non-randomized, prospectively documented series of 143 patients with histologically positive nodes in the neck or parotid was analyzed. There were 152 dissected necks or parotids: 45 of these received postoperative radiotherapy, 6 x 5.5 Gy fractions over 3 weeks; 107 were not irradiated.
  
  
  RESULTS
  The regional recurrence rate was 6.5% in the irradiated group, compared with 18.7% in the non-irradiated group (p = .055). The irradiated group, however, had more extensive nodal involvement than the non-irradiated group: 65% had two or more positive nodes, and 48% had extracapsular spread, compared with 40% and 19%, respectively, in the non-irradiated group. Survival was significantly worse when there was extracapsular spread (p < .05) or multiple node involvement (p < .01). By multivariate analysis, the use of adjuvant radiotherapy was associated with a trend toward improved regional control (p = .065), but survival was not improved.
  
  
  CONCLUSIONS
  Adjuvant radiotherapy was associated with improved control of metastatic malignant melanoma in the neck and parotid; however, statistical significance was not reached. A prospective trial should be supported to clarify this question.
authors.affiliation: Sydney Melanoma Unit, Royal Prince Alfred Hospital, Australia.
authors.forename: C J
authors.initials: CJ
authors.lastname: O'Brien
authors.forename: K
authors.initials: K
authors.lastname: Petersen-Schaefer
authors.forename: G N
authors.initials: GN
authors.lastname: Stevens
authors.forename: P C
authors.initials: PC
authors.lastname: Bass
authors.forename: P
authors.initials: P
authors.lastname: Tew
authors.forename: V J
authors.initials: VJ
authors.lastname: Gebski
authors.forename: J F
authors.initials: JF
authors.lastname: Thompson
authors.forename: W H
authors.initials: WH
authors.lastname: McCarthy
mesh_terms: D005260:Female; D006258:Head and Neck Neoplasms / Q000401:mortality / Q000532:radiotherapy / Q000556:secondary / Q000601:surgery*; D006801:Humans; D008197:Lymph Node Excision; D008297:Male; D008545:Melanoma / Q000401:mortality / Q000532:radiotherapy / Q000601:surgery*; D009364:Neoplasm Recurrence, Local; D010306:Parotid Gland / Q000601:surgery*; D010307:Parotid Neoplasms / Q000401:mortality / Q000532:radiotherapy / Q000556:secondary / Q000601:surgery*; D011446:Prospective Studies; D018714:Radiotherapy, Adjuvant; D016019:Survival Analysis