Prevention of local recurrence after surgical debulking of nodal and subcutaneous melanoma deposits by hypofractionated radiation

Background: Local recurrence (LR after surgical debulking of nodal or subcu taneous melanoma deposits defeats the purpose of operation and may worsen p rognosis if the procedure was performed for stage III disease. To decrease LR rates in this setting, we extended the previously described role of hypo fractionated radiation for melanoma deposits of the neck to all situations where the patient was felt to be at high risk for postoperative relapse aft er resection of bulky disease. Methods: Hypofractionated external beam radiation was administered in 6-Gy doses for 5 fractions (total dose 30 Gy, given over a median of 15 elapsed days) to 42 resected melanoma deposit sites in 41 patients. Results: Stages of the 41 patients at the time of treatment were: 22 stage III and 19 stage IV. All patients had complete gross resection of disease a t the radiation site before radiation. Mean time between operation and init iation of radiation was 4 weeks. The 42 sites of treatment included 27 neck , 9 axilla, 3 groin, and 3 subcutaneous deposits. There were no treatment-r elated deaths; side effects were minimal and self-limited. Transient erythe ma. desquamation, fibrosis, telangiectasias, and mucositis, parotiditis, an d xerostomia (for head and neck radiation) were reported, but no patient re quired interruption of therapy for these events. Of the 42 treated sites, o nly 2 recurred in the treatment field tone neck. one axilla) during the mea n follow-up time of 22,4 months, for a treatment failure rate of 4.8%. This represents improved local control compared with patients treated with surg ery alone at our institution and with published recurrence rates. Conclusions: The addition of hypofractionated radiation therapy after resec tion of nodal and subcutaneous melanoma deposits at a variety of sites is a rapid and well-tolerated method of providing excellent local control.