title: Radiation therapy field extent for adjuvant treatment of axillary metastases from malignant melanoma.
abstract: OBJECTIVE
  To compare treatment-related outcomes and toxicity for patients with axillary lymph node metastases from malignant melanoma treated with postoperative radiation therapy (RT) to either the axilla only or both the axilla and supraclavicular fossa (extended field [EF]).
  
  
  METHODS
  The medical records of 200 consecutive patients treated with postoperative RT for axillary lymph node metastases from malignant melanoma were retrospectively reviewed. All patients received postoperative hypofractionated RT for high-risk features; 95 patients (48%) received RT to the axilla only and 105 patients (52%) to the EF.
  
  
  RESULTS
  At a median follow-up of 59 months, 111 patients (56%) had sustained relapse, and 99 patients (50%) had died. The 5-year overall survival, disease-free survival, and distant metastasis-free survival rates were 51%, 43%, and 46%, respectively. The 5-year axillary control rate was 88%. There was no difference in axillary control rates on the basis of the treated field (89% for axilla only vs. 86% for EF; p = 0.4). Forty-seven patients (24%) developed treatment-related complications. On both univariate and multivariate analyses, only treatment with EF irradiation was significantly associated with increased treatment-related complications.
  
  
  CONCLUSIONS
  Adjuvant hypofractionated RT to the axilla only for metastatic malignant melanoma with high-risk features is an effective method to control axillary disease. Limiting the radiation field to the axilla only produced equivalent axillary control rates to EF and resulted in lower treatment-related complication rates.
authors.affiliation: Department of Radiation Oncology, The University of Texas M. D. Anderson Cancer Center, Houston, TX 77030, USA.
authors.forename: Beth M
authors.initials: BM
authors.lastname: Beadle
authors.forename: B Ashleigh
authors.initials: BA
authors.lastname: Guadagnolo
authors.forename: Matthew T
authors.initials: MT
authors.lastname: Ballo
authors.forename: Jeffrey E
authors.initials: JE
authors.lastname: Lee
authors.forename: Jeffrey E
authors.initials: JE
authors.lastname: Gershenwald
authors.forename: Janice N
authors.initials: JN
authors.lastname: Cormier
authors.forename: Paul F
authors.initials: PF
authors.lastname: Mansfield
authors.forename: Merrick I
authors.initials: MI
authors.lastname: Ross
authors.forename: Gunar K
authors.initials: GK
authors.lastname: Zagars
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000704:Analysis of Variance; D001365:Axilla; D018572:Disease-Free Survival; D019583:Dose Fractionation, Radiation; D005260:Female; D006801:Humans; D015182:Lymphatic Irradiation / Q000379:methods*; D008207:Lymphatic Metastasis / Q000000981:diagnostic imaging / Q000473:pathology / Q000532:radiotherapy; D008297:Male; D008545:Melanoma / Q000401:mortality / Q000532:radiotherapy* / Q000556:secondary / Q000601:surgery; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000401:mortality; D011859:Radiography; D018714:Radiotherapy, Adjuvant / Q000009:adverse effects; D012878:Skin Neoplasms / Q000473:pathology / Q000532:radiotherapy / Q000601:surgery; D016896:Treatment Outcome; D055815:Young Adult