title: Patterns of Recurrence in Patients with Stage IIIB/C Cutaneous Melanoma of the Head and Neck Following Surgery With and Without Adjuvant Radiation Therapy: Is Isolated Regional Recurrence Salvageable?
abstract: BACKGROUND
  Understanding recurrence patterns is vital for guiding treatment. This study describes recurrence patterns for patients with stage IIIB/C head and neck melanoma (HNM) after therapeutic lymph node dissection (TLND) ± adjuvant radiation therapy (RT). We also report outcomes for salvage therapy for patients with isolated regional relapse.
  
  
  METHODS
  A single-institution prospective database of 173 patients with American Joint Committee on Cancer (AJCC) stage IIIB/C HNM undergoing TLND between 1997 and 2012 was retrospectively reviewed. Timing and patterns of recurrence were reviewed. Univariable and multivariable analyses were undertaken using the Kaplan-Meier and Cox regression methods to determine factors predictive of recurrence. Median follow-up was 32 months.
  
  
  RESULTS
  Adjuvant RT was administered to 66/173 (38 %) patients. Patients selected for RT had a higher AJCC stage and had more extracapsular invasion. The 5-year distant, cervical nodal and in-transit recurrence rates were 38, 10, and 13 %, respectively, following surgery alone compared with 60, 17, and 31 %, respectively, for the adjuvant RT group. The head and neck regional 5-year recurrence rate (combining in-basin nodal and in-transit) was 23 % for the entire cohort. Isolated cervical recurrence occurred in 19 patients: 17/19 underwent salvage surgery (10/17 patients received RT after salvage surgery) and 2/19 had RT alone. However, distant recurrence occurred in 12/19 salvage patients, with most occurring within 12 months, while 4/19 were disease free.
  
  
  CONCLUSIONS
  Using a selective approach for adjuvant RT, isolated cervical recurrence after TLND is uncommon. Isolated cervical recurrence can be salvaged effectively with further local therapy; however, distant disease frequently follows.
authors.affiliation: Department of Radiation Oncology, Princess Alexandra Hospital, The University of Queensland, Woolloongabba, QLD, Australia.
authors.forename: Samantha
authors.initials: S
authors.lastname: Barbour
authors.affiliation: Queensland Melanoma Project, Discipline of Surgery, Princess Alexandra Hospital, The University of Queensland, Woolloongabba, QLD, Australia.
authors.forename: B
authors.initials: B
authors.lastname: Mark Smithers
authors.affiliation: Queensland Melanoma Project, Discipline of Surgery, Princess Alexandra Hospital, The University of Queensland, Woolloongabba, QLD, Australia.
authors.forename: Chris
authors.initials: C
authors.lastname: Allan
authors.affiliation: Queensland Melanoma Project, Discipline of Surgery, Princess Alexandra Hospital, The University of Queensland, Woolloongabba, QLD, Australia.
authors.forename: Gerard
authors.initials: G
authors.lastname: Bayley
authors.affiliation: Queensland Melanoma Project, Discipline of Surgery, Princess Alexandra Hospital, The University of Queensland, Woolloongabba, QLD, Australia.
authors.forename: Janine
authors.initials: J
authors.lastname: Thomas
authors.affiliation: Department of Radiation Oncology, Princess Alexandra Hospital, The University of Queensland, Woolloongabba, QLD, Australia.|Queensland Melanoma Project, Discipline of Surgery, Princess Alexandra Hospital, The University of Queensland, Woolloongabba, QLD, Australia.
authors.forename: Matthew
authors.initials: M
authors.lastname: Foote
authors.affiliation: Department of Radiation Oncology, Princess Alexandra Hospital, The University of Queensland, Woolloongabba, QLD, Australia.|Queensland Melanoma Project, Discipline of Surgery, Princess Alexandra Hospital, The University of Queensland, Woolloongabba, QLD, Australia.
authors.forename: Bryan
authors.initials: B
authors.lastname: Burmeister
authors.affiliation: Queensland Melanoma Project, Discipline of Surgery, Princess Alexandra Hospital, The University of Queensland, Woolloongabba, QLD, Australia. a.barbour@uq.edu.au.|Surgical Oncology Group, School of Medicine, Translational Research Institute, The University of Queensland, Woolloongabba, QLD, Australia. a.barbour@uq.edu.au.
authors.forename: Andrew P
authors.initials: AP
authors.lastname: Barbour
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000704:Analysis of Variance; D018572:Disease-Free Survival; D005260:Female; D006258:Head and Neck Neoplasms / Q000473:pathology / Q000532:radiotherapy* / Q000601:surgery; D006801:Humans; D008198:Lymph Nodes / Q000473:pathology / Q000601:surgery; D008207:Lymphatic Metastasis; D008297:Male; D008545:Melanoma / Q000532:radiotherapy / Q000556:secondary / Q000601:surgery*; D008875:Middle Aged; D037981:Neck Dissection; D009361:Neoplasm Invasiveness; D009364:Neoplasm Recurrence, Local / Q000628:therapy*; D009367:Neoplasm Staging; D018714:Radiotherapy, Adjuvant; D012189:Retrospective Studies; D016879:Salvage Therapy; D012878:Skin Neoplasms / Q000473:pathology* / Q000532:radiotherapy / Q000601:surgery*; D015996:Survival Rate; D055815:Young Adult