title: Prevention of local recurrence after surgical debulking of nodal and subcutaneous melanoma deposits by hypofractionated radiation.
abstract: BACKGROUND
  Local recurrence (LR) after surgical debulking of nodal or subcutaneous melanoma deposits defeats the purpose of operation and may worsen prognosis if the procedure was performed for stage III disease. To decrease LR rates in this setting, we extended the previously described role of hypofractionated radiation for melanoma deposits of the neck to all situations where the patient was felt to be at high risk for postoperative relapse after resection of bulky disease.
  
  
  METHODS
  Hypofractionated external beam radiation was administered in 6-Gy doses for 5 fractions (total dose 30 Gy, given over a median of 15 elapsed days) to 42 resected melanoma deposit sites in 41 patients.
  
  
  RESULTS
  Stages of the 41 patients at the time of treatment were: 22 stage III and 19 stage IV. All patients had complete gross resection of disease at the radiation site before radiation. Mean time between operation and initiation of radiation was 4 weeks. The 42 sites of treatment included 27 neck, 9 axilla, 3 groin, and 3 subcutaneous deposits. There were no treatment-related deaths; side effects were minimal and self-limited. Transient erythema, desquamation, fibrosis, telangiectasias, and mucositis, parotiditis, and xerostomia (for head and neck radiation) were reported, but no patient required interruption of therapy for these events. Of the 42 treated sites, only 2 recurred in the treatment field (one neck, one axilla) during the mean follow-up time of 22.4 months, for a treatment failure rate of 4.8%. This represents improved local control compared with patients treated with surgery alone at our institution and with published recurrence rates.
  
  
  CONCLUSIONS
  The addition of hypofractionated radiation therapy after resection of nodal and subcutaneous melanoma deposits at a variety of sites is a rapid and well-tolerated method of providing excellent local control.
authors.affiliation: Department of Surgery, Oregon Health Sciences University, Portland 97201-3098, USA.
authors.forename: K T
authors.initials: KT
authors.lastname: Morris
authors.forename: C M
authors.initials: CM
authors.lastname: Marquez
authors.forename: J M
authors.initials: JM
authors.lastname: Holland
authors.forename: J T
authors.initials: JT
authors.lastname: Vetto
mesh_terms: D000328:Adult; D000368:Aged; D001365:Axilla; D015331:Cohort Studies; D019583:Dose Fractionation, Radiation; D005260:Female; D006119:Groin; D006801:Humans; D008198:Lymph Nodes / Q000601:surgery*; D008207:Lymphatic Metastasis / Q000532:radiotherapy; D008297:Male; D008545:Melanoma / Q000473:pathology / Q000532:radiotherapy* / Q000601:surgery*; D008875:Middle Aged; D009333:Neck; D009364:Neoplasm Recurrence, Local / Q000517:prevention & control*; D011184:Postoperative Period; D012878:Skin Neoplasms / Q000532:radiotherapy* / Q000556:secondary / Q000601:surgery*; D016896:Treatment Outcome