Radiation therapy field extent for adjuvant treatment of axillary metastases from malignant melanoma.
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.
Beadle
Beth M
BM
Department of Radiation Oncology, The University of Texas M. D. Anderson Cancer Center, Houston, TX 77030, USA.
Guadagnolo
B Ashleigh
BA
Ballo
Matthew T
MT
Lee
Jeffrey E
JE
Gershenwald
Jeffrey E
JE
Cormier
Janice N
JN
Mansfield
Paul F
PF
Ross
Merrick I
MI
Zagars
Gunar K
GK
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