title: Stage III melanoma in the axilla: patterns of regional recurrence after surgery with and without adjuvant radiation therapy.
abstract: OBJECTIVE
  To describe the anatomic distribution of regionally recurrent disease in patients with stage III melanoma in the axilla after curative-intent surgery with and without adjuvant radiation therapy.
  
  
  METHODS
  A single-institution, retrospective analysis of a prospective database of 277 patients undergoing curative-intent treatment for stage III melanoma in the axilla between 1992 and 2012 was completed. For patients who received radiation therapy and those who did not, patterns of regional recurrence were analyzed, and univariate analyses were performed to assess for potential factors associated with location of recurrence.
  
  
  RESULTS
  There were 121 patients who received adjuvant radiation therapy because their clinicopathologic features conferred a greater risk of regional recurrence. There were 156 patients who received no radiation therapy. The overall axillary control rate was 87%. There were 37 patients with regional recurrence; 17 patients had received adjuvant radiation therapy (14%), and 20 patients (13%) had not. The likelihood of in-field nodal recurrence was significantly less in the adjuvant radiation therapy group (P=.01) and significantly greater in sites adjacent to the axilla (P=.02). Patients with high-risk clinicopathologic features who did not receive adjuvant radiation therapy also tended to experience in-field failure rather than adjacent-field failure.
  
  
  CONCLUSIONS
  Patients who received adjuvant radiation therapy were more likely to experience recurrence in the adjacent-field regions rather than in the in-field regions. This may not simply reflect higher-risk pathology. Using this data, it may be possible to improve outcomes by reducing the number of adjacent-field recurrences after adjuvant radiation therapy.
authors.affiliation: Department of Radiation Oncology, Princess Alexandra Hospital, Brisbane, Australia. mark.pinkham@health.qld.gov.au
authors.forename: Mark B
authors.initials: MB
authors.lastname: Pinkham
authors.forename: Matthew C
authors.initials: MC
authors.lastname: Foote
authors.forename: Elizabeth
authors.initials: E
authors.lastname: Burmeister
authors.forename: Janine
authors.initials: J
authors.lastname: Thomas
authors.forename: Janelle
authors.initials: J
authors.lastname: Meakin
authors.forename: B Mark
authors.initials: BM
authors.lastname: Smithers
authors.forename: Bryan H
authors.initials: BH
authors.lastname: Burmeister
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000704:Analysis of Variance; D001365:Axilla; D005260:Female; D006801:Humans; D008197:Lymph Node Excision / Q000379:methods; D008207:Lymphatic Metastasis; D008297:Male; D008545:Melanoma / Q000473:pathology* / Q000517:prevention & control / Q000532:radiotherapy* / Q000556:secondary / Q000601:surgery; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000473:pathology* / Q000517:prevention & control; D009367:Neoplasm Staging; D011879:Radiotherapy Dosage; D018714:Radiotherapy, Adjuvant / Q000706:statistics & numerical data; D012189:Retrospective Studies; D012878:Skin Neoplasms / Q000473:pathology* / Q000517:prevention & control / Q000532:radiotherapy* / Q000601:surgery; D055815:Young Adult