title: Loco-regional control after postoperative radiotherapy for patients with regional nodal metastases from melanoma.
abstract: BACKGROUND
  The role of adjuvant radiation therapy (RT) following nodal surgery in malignant melanoma remains controversial. There are no published randomised trials comparing surgery alone to surgery with postoperative RT.
  
  
  OBJECTIVE
  The purpose of the present retrospective study was to review the results of loco-regional control after postoperative RT in patients with nodal metastases of melanoma. Seventy-seven patients with high-risk disease (lymph nodes > or =3 cm, more than three lymph nodes involved, extracapsular extension and recurrent disease) were treated with adjuvant RT. Hypofractionation was used in 65 patients and conventional fractionation in 12 patients.
  
  
  RESULTS
  Seventy-seven patients with nodal metastases from melanoma were managed with lymphadenectomy and radiation, with or without systemic therapy. The median age was 56 years old (range: 21-83). There were 47 males (61%) and 30 females (39%). Loco-regional control was observed in 95% of patients (73/77). The actuarial 5-year in-field loco-regional control rate was 90% (mean: 105 months; CI95%: 96-115 months). Median metastasis disease- free survival (MDFS) was 16 months (CI95%: 13-18 months). Median survival time (MST) for the entire group was 26 months (CI95%: 18-34 months). MST according to the localisation of node metastases (groin, axilla and cervical) was also analysed, without statistically significant differences (p=0.08). Concerning the number of risk factors score, analysis of survival did not show statistically significant differences (p=0.055).
  
  
  CONCLUSIONS
  Despite the high incidence of distant metastases, loco-regional control remains an important goal in the management of melanoma. Surgery and adjuvant RT provides excellent loco-regional control, although distant metastases remain the major cause of mortality.
authors.affiliation: Department of Radiation Oncology, Institute of Haematology and Oncology, Hospital Clínic, Institut d'Investigacions Biomèdiques August Pi i Sunyer, University of Barcelona, Barcelona, Spain. cconill@clinic.ub.es
authors.forename: Carlos
authors.initials: C
authors.lastname: Conill
authors.forename: Izaskun
authors.initials: I
authors.lastname: Valduvieco
authors.forename: Josep
authors.initials: J
authors.lastname: Domingo-Domènech
authors.forename: Pedro
authors.initials: P
authors.lastname: Arguis
authors.forename: Sergi
authors.initials: S
authors.lastname: Vidal-Sicart
authors.forename: Antonio
authors.initials: A
authors.lastname: Vilalta
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003131:Combined Modality Therapy; D005260:Female; D006801:Humans; D008197:Lymph Node Excision; D008207:Lymphatic Metastasis; D008297:Male; D008545:Melanoma / Q000532:radiotherapy* / Q000556:secondary; D008875:Middle Aged; D009367:Neoplasm Staging; D011182:Postoperative Care; D011379:Prognosis; D012189:Retrospective Studies; D015996:Survival Rate; D016896:Treatment Outcome