title: A multi-institutional retrospective analysis of external radiotherapy for mucosal melanoma of the head and neck in Northern Japan.
abstract: OBJECTIVE
  A multi-institutional retrospective study was performed in northern Japan to analyze the outcome of external radiotherapy as the definitive treatment modality for localized mucosal melanoma of the head and neck.
  
  
  METHODS
  Thirty-one patients with localized mucosal melanoma of the head and neck treated by external radiotherapy at nine institutions of the Northern Japan Radiation Therapy Oncology Group between 1980 and 1999 were enrolled in this study. Radiotherapy alone was performed in 21 patients, and the remaining 10 patients received postoperative radiotherapy for gross residual tumors. The fraction size of radiotherapy varied from 1.5-13.8 Gy, with the total dose ranging from 32-64 Gy (median, 50 Gy). The follow-up periods ranged from 1-214 months (median, 16 months).
  
  
  RESULTS
  Complete or partial responses were observed in 9 patients (29%) and 18 patients (58%), respectively. Local recurrence occurred in 13 patients (41.9%) and distant metastasis occurred in 11 patients (35.5%). Most incidences of local recurrence and distant metastasis developed within 2 years after the initial treatment. Overall cause-specific survival rates of patients at 1 and 3 years were 73% and 33%, respectively. Univariate analysis showed that high dose per fractionated radiotherapy doses (>or=3 Gy) was associated with better prognosis for both local control (p = 0.048) and survival (p = 0.045). Multivariate analysis indicated that age (better prognosis in younger patients, p = 0.046) was the only significant factor. Radiotherapy for gross residual lesions after surgery did not seem to impact the significant gain of local control and survival. We observed two fatal late complications of mucosal ulcer and bleeding in the high dose per fractionated radiotherapy group.
  
  
  CONCLUSIONS
  Radiotherapy at a dose of 3 Gy or more per fraction was effective in gaining local control in patients with localized mucosal melanoma of the head and neck, and subsequently better survival was possible, especially in younger patients.
authors.affiliation: Northern Japanese Radiation Therapy Oncology Group, Department of Radiology, Yamagata City Hospital, Yamagata, Japan. wadajin@rad.med.tohoku.ac.jp
authors.forename: Hitoshi
authors.initials: H
authors.lastname: Wada
authors.forename: Kenji
authors.initials: K
authors.lastname: Nemoto
authors.forename: Yoshihiro
authors.initials: Y
authors.lastname: Ogawa
authors.forename: Masato
authors.initials: M
authors.lastname: Hareyama
authors.forename: Hiroshi
authors.initials: H
authors.lastname: Yoshida
authors.forename: Akio
authors.initials: A
authors.lastname: Takamura
authors.forename: Keiichi
authors.initials: K
authors.lastname: Ohmori
authors.forename: Yasushi
authors.initials: Y
authors.lastname: Hamamoto
authors.forename: Tadashi
authors.initials: T
authors.lastname: Sugita
authors.forename: Mari
authors.initials: M
authors.lastname: Saitoh
authors.forename: Shogo
authors.initials: S
authors.lastname: Yamada
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000704:Analysis of Variance; D019583:Dose Fractionation, Radiation; D005260:Female; D006258:Head and Neck Neoplasms / Q000401:mortality / Q000532:radiotherapy*; D006801:Humans; D007564:Japan; D008297:Male; D008545:Melanoma / Q000401:mortality / Q000532:radiotherapy* / Q000556:secondary; D008875:Middle Aged; D009092:Mucous Membrane; D009364:Neoplasm Recurrence, Local; D011879:Radiotherapy Dosage; D012189:Retrospective Studies; D015996:Survival Rate