Locally advanced melanoma - Results of postoperative hypofractionated radiation therapy

BACKGROUND. High rates of locoregional recurrence have been reported from s urgical series of locally advanced melanoma. In this study, the outcomes of patients treated with surgery and postoperative hypofractionated radiation therapy were reviewed to assess local recurrence and survival. METHODS, From 1989 to 1998, 174 patients with International Union Against C ancer Stage I-III melanoma received postoperative radiation therapy, either as a component of their initial management or following surgery for recurr ence. Radiation was delivered to the primary site in 35 cases and involved regional lymph nodes in 139. The indications for irradiation included micro scopically positive surgical margins or other adverse pathologic features. All patients received a hypofractionated schedule of 30-36 grays (Gy) in 5- 7 fractions over 2.5 weeks. RESULTS. Recurrence within the radiation fields was identified in 20 patien ts (11%) at a median lime of 6 months. There was no difference in recurrenc e rates for patients with microscopically positive margins compared with ot her indications for adjuvant treatment. The main complication of treatment was symptomatic arm lymphedema in 58% of patients following axillary dissec tion and postoperative irradiation. The median disease specific survival fo r the entire group was 25 months from radiation therapy, and the 5-year sur vival was 41%. The only factor that predicted significantly for decreased s urvival was infield recurrence (the median survival periods were 13 months and 35 months for those with and without infield recurrence, P < 0.00001). The median time to the development of distant metastasis was 19 months. CONCLUSIONS. Despite the high incidence of distant metastasis, locoregional control remains an important goal in the management of melanoma. Compared with published surgical data, postoperative adjuvant radiation therapy give n according to a hypofractionated schedule was effective in reducing local recurrence in patients at high risk of locoregional failure. Cancer 2000;88 :88-94. (C) 2000 American Cancer Society.