Locally advanced melanoma: results of postoperative hypofractionated radiation therapy.
BACKGROUND
High rates of locoregional recurrence have been reported from surgical series of locally advanced melanoma. In this study, the outcomes of patients treated with surgery and postoperative hypofractionated radiation therapy were reviewed to assess local recurrence and survival.


METHODS
From 1989 to 1998, 174 patients with International Union Against Cancer Stage I-III melanoma received postoperative radiation therapy, either as a component of their initial management or following surgery for recurrence. Radiation was delivered to the primary site in 35 cases and involved regional lymph nodes in 139. The indications for irradiation included microscopically positive surgical margins or other adverse pathologic features. All patients received a hypofractionated schedule of 30-36 grays (Gy) in 5-7 fractions over 2.5 weeks.


RESULTS
Recurrence within the radiation fields was identified in 20 patients (11%) at a median time of 6 months. There was no difference in recurrence rates for patients with microscopically positive margins compared with other indications for adjuvant treatment. The main complication of treatment was symptomatic arm lymphedema in 58% of patients following axillary dissection and postoperative irradiation. The median disease specific survival for the entire group was 25 months from radiation therapy, and the 5-year survival was 41%. The only factor that predicted significantly for decreased survival was infield recurrence (the median survival periods were 13 months and 35 months for those with and without infield recurrence, P < 0.0001). The median time to the development of distant metastasis was 19 months.


CONCLUSIONS
Despite the high incidence of distant metastasis, locoregional control remains an important goal in the management of melanoma. Compared with published surgical data, postoperative adjuvant radiation therapy given according to a hypofractionated schedule was effective in reducing local recurrence in patients at high risk of locoregional failure.
Stevens
G
G
Department of Radiation Oncology, Royal Prince Alfred Hospital, Sydney, Australia.
Thompson
J F
JF
Firth
I
I
O'Brien
C J
CJ
McCarthy
W H
WH
Quinn
M J
MJ
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002648:Child; D019583:Dose Fractionation, Radiation; D005260:Female; D006801:Humans; D008297:Male; D008545:Melanoma / Q000532:radiotherapy* / Q000556:secondary* / Q000601:surgery; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000517:prevention & control*; D009367:Neoplasm Staging; D018714:Radiotherapy, Adjuvant; D012878:Skin Neoplasms / Q000473:pathology* / Q000532:radiotherapy* / Q000601:surgery; D016019:Survival Analysis; D016896:Treatment Outcome