ADJUVANT RADIOTHERAPY FOLLOWING NECK DISSECTION AND PAROTIDECTOMY FORMETASTATIC MALIGNANT-MELANOMA

Background. Regional recurrence remains a problem in the management of patients with metastatic malignant melanoma in the cervical lymph nod es and parotid. In this study, the influence of the number of positive nodes, extracapsular spread, and the use of adjuvant radiotherapy on regional control and survival were analyzed. Methods. A non-randomized , prospectively documented series of 143 patients with histologically positive nodes in the neck or parotid was analyzed. There were 152 dis sected necks or parotids: 45 of these received postoperative radiother apy, 6 x 5.5 Gy fractions over 3 weeks; 107 were not irradiated. Resul ts. The regional recurrence rate was 6.5% in the irradiated group, com pared with 18.7% in the non-irradiated group (p = .055). The irradiate d group, however, had more extensive nodal involvement than the non-ir radiated group: 65% had two or more positive nodes, and 48% had extrac apsular spread, compared with 40% and 19%, respectively, in the non-ir radiated group. Survival was significantly worse when there was extrac apsular spread (p < .05) or multiple node involvement (p < .01). By mu ltivariate analysis, the use of adjuvant radiotherapy was associated w ith a trend toward improved regional control (p = .065), but survival was not improved. Conclusions. Adjuvant radiotherapy was associated wi th improved control of metastatic malignant melanoma in the neck and p arotid; however, statistical significance was not reached. A prospecti ve trial should be supported to clarify this question. (C) 1997 John W iley & Sons, Inc.