Adjuvant irradiation for axillary metastases from malignant melanoma
Identifieur interne : 000786 ( PascalFrancis/Corpus ); précédent : 000785; suivant : 000787Adjuvant irradiation for axillary metastases from malignant melanoma
Auteurs : Matthew T. Ballo ; Eric A. Strom ; Gunar K. Zagars ; Agop Y. Bedikian ; Victor G. Prieto ; Paul F. Mansfield ; Jeffrey E. Lee ; Jeffrey E. Gershenwald ; Merrick I. RossSource :
- International journal of radiation oncology, biology, physics [ 0360-3016 ] ; 2002.
Descripteurs français
- Pascal (Inist)
English descriptors
- KwdEn :
Abstract
Purpose: To evaluate the outcome and treatment-related toxicity for patients with axillary lymph node metastases from malignant melanoma treated with surgery and radiation, with or without systemic therapy. Methods and Materials: The medical records of 89 consecutive patients with axillary lymph node metastases from malignant melanoma were retrospectively reviewed. All patients underwent axillary dissection and postoperative radiation to a median dose of 30 Gy at 6 Gy/fraction delivered twice weekly. In 3 patients referred with microscopic residual disease, a single boost (4-6 Gy) was given to a reduced field. All but 2 patients were referred because their axillary dissections revealed features believed to predict a 30-50% risk of subsequent axillary recurrence: lymph nodes ≥3 cm in size (54 patients), ≥4 lymph nodes positive (44), the presence of extracapsular extension (69), recurrent disease after initial surgical resection (23), or multiple risk factors (77). Fifty-one patients received systemic therapy before or after radiation therapy. Results: At a median follow-up of 63 months, 47 patients had relapsed and 43 patients had died. The actuarial overall and disease-free survival rates at 5 years were 50% and 46%, respectively. The actuarial axillary control and distant metastasis-free survival rates at 5 years were 87% and 49%, respectively. Univariate analysis revealed that the probability of axillary control was inferior when the axillary disease measured >6 cm in size (72% vs. 93%, p = 0.02), the location of the primary tumor was unknown (74% vs. 93%, p = 0.02), the axillary failure occurred within 18 months from diagnosis of the primary melanoma (84% vs. 100%, p = 0.04), or the Breslow thickness was >4 mm (80% vs. 96%, p = 0.04). Additionally, there was an inferior distant metastasis-free and disease-free survival when there were >2 nodes positive for metastatic disease, the primary lesion had a Breslow thickness >4 mm, or the axillary failure occurred within 18 months from diagnosis of the primary melanoma. On multivariate analysis, the significantly inferior distant metastasis-free and disease-free survival seen when >2 nodes were positive or the recurrence occurred within 18 months remained significant. The small number of axillary failures precluded multivariate analysis for axillary control; however, stratified analysis suggested that size >6 cm was the factor most closely associated with subsequent axillary failure. Twenty-six patients developed treatment-related arm edema. Classification according to the severity of edema yielded 5-year actuarial arm edema rates of 21%, 19%, and 1%, for Grade 1 (transient or asymptomatic), Grade 2 (requiring medical intervention), or Grade 3 (requiring surgical intervention) edema, respectively. Conclusion: Adjuvant radiation therapy using a hypofractionated regimen resulted in an 87% 5-year axillary control rate, superior to the 50-70% local control achieved with surgery alone for lymph node metastases from melanoma when high-risk features are present. Improvements are needed for patients with bulky nodal masses >6 cm in size. Mild-to-moderate arm edema was common, but manageable. The degree to which radiotherapy adds to the risk of arm edema after axillary dissection alone cannot be addressed in the present analysis.
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Format Inist (serveur)
NO : | PASCAL 02-0266455 INIST |
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ET : | Adjuvant irradiation for axillary metastases from malignant melanoma |
AU : | BALLO (Matthew T.); STROM (Eric A.); ZAGARS (Gunar K.); BEDIKIAN (Agop Y.); PRIETO (Victor G.); MANSFIELD (Paul F.); LEE (Jeffrey E.); GERSHENWALD (Jeffrey E.); ROSS (Merrick I.) |
AF : | Department of Radiation Oncology, University of Texas M D. Anderson Cancer Center/Houston, TX/Etats-Unis (1 aut., 2 aut., 3 aut.); Department of Melanoma Medical Oncology, University of Texas M D. Anderson Cancer Center/Houston, TX/Etats-Unis (4 aut.); Department of Pathology, University of Texas M D. Anderson Cancer Center/Houston, TX/Etats-Unis (5 aut.); Department of Surgical Oncology, University of Texas M D. Anderson Cancer Center/Houston, TX/Etats-Unis (6 aut., 7 aut., 8 aut., 9 aut.) |
DT : | Publication en série; Niveau analytique |
SO : | International journal of radiation oncology, biology, physics; ISSN 0360-3016; Coden IOBPD3; Etats-Unis; Da. 2002; Vol. 52; No. 4; Pp. 964-972; Bibl. 23 ref. |
LA : | Anglais |
EA : | Purpose: To evaluate the outcome and treatment-related toxicity for patients with axillary lymph node metastases from malignant melanoma treated with surgery and radiation, with or without systemic therapy. Methods and Materials: The medical records of 89 consecutive patients with axillary lymph node metastases from malignant melanoma were retrospectively reviewed. All patients underwent axillary dissection and postoperative radiation to a median dose of 30 Gy at 6 Gy/fraction delivered twice weekly. In 3 patients referred with microscopic residual disease, a single boost (4-6 Gy) was given to a reduced field. All but 2 patients were referred because their axillary dissections revealed features believed to predict a 30-50% risk of subsequent axillary recurrence: lymph nodes ≥3 cm in size (54 patients), ≥4 lymph nodes positive (44), the presence of extracapsular extension (69), recurrent disease after initial surgical resection (23), or multiple risk factors (77). Fifty-one patients received systemic therapy before or after radiation therapy. Results: At a median follow-up of 63 months, 47 patients had relapsed and 43 patients had died. The actuarial overall and disease-free survival rates at 5 years were 50% and 46%, respectively. The actuarial axillary control and distant metastasis-free survival rates at 5 years were 87% and 49%, respectively. Univariate analysis revealed that the probability of axillary control was inferior when the axillary disease measured >6 cm in size (72% vs. 93%, p = 0.02), the location of the primary tumor was unknown (74% vs. 93%, p = 0.02), the axillary failure occurred within 18 months from diagnosis of the primary melanoma (84% vs. 100%, p = 0.04), or the Breslow thickness was >4 mm (80% vs. 96%, p = 0.04). Additionally, there was an inferior distant metastasis-free and disease-free survival when there were >2 nodes positive for metastatic disease, the primary lesion had a Breslow thickness >4 mm, or the axillary failure occurred within 18 months from diagnosis of the primary melanoma. On multivariate analysis, the significantly inferior distant metastasis-free and disease-free survival seen when >2 nodes were positive or the recurrence occurred within 18 months remained significant. The small number of axillary failures precluded multivariate analysis for axillary control; however, stratified analysis suggested that size >6 cm was the factor most closely associated with subsequent axillary failure. Twenty-six patients developed treatment-related arm edema. Classification according to the severity of edema yielded 5-year actuarial arm edema rates of 21%, 19%, and 1%, for Grade 1 (transient or asymptomatic), Grade 2 (requiring medical intervention), or Grade 3 (requiring surgical intervention) edema, respectively. Conclusion: Adjuvant radiation therapy using a hypofractionated regimen resulted in an 87% 5-year axillary control rate, superior to the 50-70% local control achieved with surgery alone for lymph node metastases from melanoma when high-risk features are present. Improvements are needed for patients with bulky nodal masses >6 cm in size. Mild-to-moderate arm edema was common, but manageable. The degree to which radiotherapy adds to the risk of arm edema after axillary dissection alone cannot be addressed in the present analysis. |
CC : | 002B04C; 002B04H02A |
FD : | Mélanome malin; Homme; Métastase; Ganglion axillaire; Chirurgie; Traitement adjuvant; Radiothérapie; Dose fractionnée; Plan traitement; Lymphoedème; Radiolésion; Efficacité traitement; Courbe survie; Rétrospective |
FG : | Tumeur maligne; Appareil circulatoire pathologie; Lymphatique pathologie |
ED : | Malignant melanoma; Human; Metastasis; Axillary ganglion; Surgery; Adjuvant treatment; Radiotherapy; Fractionated dose; Treatment planning; Lymphedema; Radiation injury; Treatment efficiency; Survival curve; Retrospective |
EG : | Malignant tumor; Cardiovascular disease; Lymphatic vessel disease |
SD : | Melanoma maligno; Hombre; Metástasis; Ganglio axilar; Cirugía; Tratamiento adyuvante; Radioterapia; Dosis fraccionada; Plan tratamiento; Linfedema; Lesión por radiación; Eficacia tratamiento; Curva sobrevivencia; Retrospectiva |
LO : | INIST-17180.354000100376130120 |
ID : | 02-0266455 |
Links to Exploration step
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<series><title level="j" type="main">International journal of radiation oncology, biology, physics</title>
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<profileDesc><textClass><keywords scheme="KwdEn" xml:lang="en"><term>Adjuvant treatment</term>
<term>Axillary ganglion</term>
<term>Fractionated dose</term>
<term>Human</term>
<term>Lymphedema</term>
<term>Malignant melanoma</term>
<term>Metastasis</term>
<term>Radiation injury</term>
<term>Radiotherapy</term>
<term>Retrospective</term>
<term>Surgery</term>
<term>Survival curve</term>
<term>Treatment efficiency</term>
<term>Treatment planning</term>
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<keywords scheme="Pascal" xml:lang="fr"><term>Mélanome malin</term>
<term>Homme</term>
<term>Métastase</term>
<term>Ganglion axillaire</term>
<term>Chirurgie</term>
<term>Traitement adjuvant</term>
<term>Radiothérapie</term>
<term>Dose fractionnée</term>
<term>Plan traitement</term>
<term>Lymphoedème</term>
<term>Radiolésion</term>
<term>Efficacité traitement</term>
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<front><div type="abstract" xml:lang="en">Purpose: To evaluate the outcome and treatment-related toxicity for patients with axillary lymph node metastases from malignant melanoma treated with surgery and radiation, with or without systemic therapy. Methods and Materials: The medical records of 89 consecutive patients with axillary lymph node metastases from malignant melanoma were retrospectively reviewed. All patients underwent axillary dissection and postoperative radiation to a median dose of 30 Gy at 6 Gy/fraction delivered twice weekly. In 3 patients referred with microscopic residual disease, a single boost (4-6 Gy) was given to a reduced field. All but 2 patients were referred because their axillary dissections revealed features believed to predict a 30-50% risk of subsequent axillary recurrence: lymph nodes ≥3 cm in size (54 patients), ≥4 lymph nodes positive (44), the presence of extracapsular extension (69), recurrent disease after initial surgical resection (23), or multiple risk factors (77). Fifty-one patients received systemic therapy before or after radiation therapy. Results: At a median follow-up of 63 months, 47 patients had relapsed and 43 patients had died. The actuarial overall and disease-free survival rates at 5 years were 50% and 46%, respectively. The actuarial axillary control and distant metastasis-free survival rates at 5 years were 87% and 49%, respectively. Univariate analysis revealed that the probability of axillary control was inferior when the axillary disease measured >6 cm in size (72% vs. 93%, p = 0.02), the location of the primary tumor was unknown (74% vs. 93%, p = 0.02), the axillary failure occurred within 18 months from diagnosis of the primary melanoma (84% vs. 100%, p = 0.04), or the Breslow thickness was >4 mm (80% vs. 96%, p = 0.04). Additionally, there was an inferior distant metastasis-free and disease-free survival when there were >2 nodes positive for metastatic disease, the primary lesion had a Breslow thickness >4 mm, or the axillary failure occurred within 18 months from diagnosis of the primary melanoma. On multivariate analysis, the significantly inferior distant metastasis-free and disease-free survival seen when >2 nodes were positive or the recurrence occurred within 18 months remained significant. The small number of axillary failures precluded multivariate analysis for axillary control; however, stratified analysis suggested that size >6 cm was the factor most closely associated with subsequent axillary failure. Twenty-six patients developed treatment-related arm edema. Classification according to the severity of edema yielded 5-year actuarial arm edema rates of 21%, 19%, and 1%, for Grade 1 (transient or asymptomatic), Grade 2 (requiring medical intervention), or Grade 3 (requiring surgical intervention) edema, respectively. Conclusion: Adjuvant radiation therapy using a hypofractionated regimen resulted in an 87% 5-year axillary control rate, superior to the 50-70% local control achieved with surgery alone for lymph node metastases from melanoma when high-risk features are present. Improvements are needed for patients with bulky nodal masses >6 cm in size. Mild-to-moderate arm edema was common, but manageable. The degree to which radiotherapy adds to the risk of arm edema after axillary dissection alone cannot be addressed in the present analysis.</div>
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<fC01 i1="01" l="ENG"><s0>Purpose: To evaluate the outcome and treatment-related toxicity for patients with axillary lymph node metastases from malignant melanoma treated with surgery and radiation, with or without systemic therapy. Methods and Materials: The medical records of 89 consecutive patients with axillary lymph node metastases from malignant melanoma were retrospectively reviewed. All patients underwent axillary dissection and postoperative radiation to a median dose of 30 Gy at 6 Gy/fraction delivered twice weekly. In 3 patients referred with microscopic residual disease, a single boost (4-6 Gy) was given to a reduced field. All but 2 patients were referred because their axillary dissections revealed features believed to predict a 30-50% risk of subsequent axillary recurrence: lymph nodes ≥3 cm in size (54 patients), ≥4 lymph nodes positive (44), the presence of extracapsular extension (69), recurrent disease after initial surgical resection (23), or multiple risk factors (77). Fifty-one patients received systemic therapy before or after radiation therapy. Results: At a median follow-up of 63 months, 47 patients had relapsed and 43 patients had died. The actuarial overall and disease-free survival rates at 5 years were 50% and 46%, respectively. The actuarial axillary control and distant metastasis-free survival rates at 5 years were 87% and 49%, respectively. Univariate analysis revealed that the probability of axillary control was inferior when the axillary disease measured >6 cm in size (72% vs. 93%, p = 0.02), the location of the primary tumor was unknown (74% vs. 93%, p = 0.02), the axillary failure occurred within 18 months from diagnosis of the primary melanoma (84% vs. 100%, p = 0.04), or the Breslow thickness was >4 mm (80% vs. 96%, p = 0.04). Additionally, there was an inferior distant metastasis-free and disease-free survival when there were >2 nodes positive for metastatic disease, the primary lesion had a Breslow thickness >4 mm, or the axillary failure occurred within 18 months from diagnosis of the primary melanoma. On multivariate analysis, the significantly inferior distant metastasis-free and disease-free survival seen when >2 nodes were positive or the recurrence occurred within 18 months remained significant. The small number of axillary failures precluded multivariate analysis for axillary control; however, stratified analysis suggested that size >6 cm was the factor most closely associated with subsequent axillary failure. Twenty-six patients developed treatment-related arm edema. Classification according to the severity of edema yielded 5-year actuarial arm edema rates of 21%, 19%, and 1%, for Grade 1 (transient or asymptomatic), Grade 2 (requiring medical intervention), or Grade 3 (requiring surgical intervention) edema, respectively. Conclusion: Adjuvant radiation therapy using a hypofractionated regimen resulted in an 87% 5-year axillary control rate, superior to the 50-70% local control achieved with surgery alone for lymph node metastases from melanoma when high-risk features are present. Improvements are needed for patients with bulky nodal masses >6 cm in size. Mild-to-moderate arm edema was common, but manageable. The degree to which radiotherapy adds to the risk of arm edema after axillary dissection alone cannot be addressed in the present analysis.</s0>
</fC01>
<fC02 i1="01" i2="X"><s0>002B04C</s0>
</fC02>
<fC02 i1="02" i2="X"><s0>002B04H02A</s0>
</fC02>
<fC03 i1="01" i2="X" l="FRE"><s0>Mélanome malin</s0>
<s5>01</s5>
</fC03>
<fC03 i1="01" i2="X" l="ENG"><s0>Malignant melanoma</s0>
<s5>01</s5>
</fC03>
<fC03 i1="01" i2="X" l="SPA"><s0>Melanoma maligno</s0>
<s5>01</s5>
</fC03>
<fC03 i1="02" i2="X" l="FRE"><s0>Homme</s0>
<s5>02</s5>
</fC03>
<fC03 i1="02" i2="X" l="ENG"><s0>Human</s0>
<s5>02</s5>
</fC03>
<fC03 i1="02" i2="X" l="SPA"><s0>Hombre</s0>
<s5>02</s5>
</fC03>
<fC03 i1="03" i2="X" l="FRE"><s0>Métastase</s0>
<s5>03</s5>
</fC03>
<fC03 i1="03" i2="X" l="ENG"><s0>Metastasis</s0>
<s5>03</s5>
</fC03>
<fC03 i1="03" i2="X" l="SPA"><s0>Metástasis</s0>
<s5>03</s5>
</fC03>
<fC03 i1="04" i2="X" l="FRE"><s0>Ganglion axillaire</s0>
<s5>04</s5>
</fC03>
<fC03 i1="04" i2="X" l="ENG"><s0>Axillary ganglion</s0>
<s5>04</s5>
</fC03>
<fC03 i1="04" i2="X" l="SPA"><s0>Ganglio axilar</s0>
<s5>04</s5>
</fC03>
<fC03 i1="05" i2="X" l="FRE"><s0>Chirurgie</s0>
<s5>05</s5>
</fC03>
<fC03 i1="05" i2="X" l="ENG"><s0>Surgery</s0>
<s5>05</s5>
</fC03>
<fC03 i1="05" i2="X" l="SPA"><s0>Cirugía</s0>
<s5>05</s5>
</fC03>
<fC03 i1="06" i2="X" l="FRE"><s0>Traitement adjuvant</s0>
<s5>06</s5>
</fC03>
<fC03 i1="06" i2="X" l="ENG"><s0>Adjuvant treatment</s0>
<s5>06</s5>
</fC03>
<fC03 i1="06" i2="X" l="SPA"><s0>Tratamiento adyuvante</s0>
<s5>06</s5>
</fC03>
<fC03 i1="07" i2="X" l="FRE"><s0>Radiothérapie</s0>
<s5>07</s5>
</fC03>
<fC03 i1="07" i2="X" l="ENG"><s0>Radiotherapy</s0>
<s5>07</s5>
</fC03>
<fC03 i1="07" i2="X" l="SPA"><s0>Radioterapia</s0>
<s5>07</s5>
</fC03>
<fC03 i1="08" i2="X" l="FRE"><s0>Dose fractionnée</s0>
<s5>08</s5>
</fC03>
<fC03 i1="08" i2="X" l="ENG"><s0>Fractionated dose</s0>
<s5>08</s5>
</fC03>
<fC03 i1="08" i2="X" l="SPA"><s0>Dosis fraccionada</s0>
<s5>08</s5>
</fC03>
<fC03 i1="09" i2="X" l="FRE"><s0>Plan traitement</s0>
<s5>09</s5>
</fC03>
<fC03 i1="09" i2="X" l="ENG"><s0>Treatment planning</s0>
<s5>09</s5>
</fC03>
<fC03 i1="09" i2="X" l="SPA"><s0>Plan tratamiento</s0>
<s5>09</s5>
</fC03>
<fC03 i1="10" i2="X" l="FRE"><s0>Lymphoedème</s0>
<s5>10</s5>
</fC03>
<fC03 i1="10" i2="X" l="ENG"><s0>Lymphedema</s0>
<s5>10</s5>
</fC03>
<fC03 i1="10" i2="X" l="SPA"><s0>Linfedema</s0>
<s5>10</s5>
</fC03>
<fC03 i1="11" i2="X" l="FRE"><s0>Radiolésion</s0>
<s5>11</s5>
</fC03>
<fC03 i1="11" i2="X" l="ENG"><s0>Radiation injury</s0>
<s5>11</s5>
</fC03>
<fC03 i1="11" i2="X" l="SPA"><s0>Lesión por radiación</s0>
<s5>11</s5>
</fC03>
<fC03 i1="12" i2="X" l="FRE"><s0>Efficacité traitement</s0>
<s5>12</s5>
</fC03>
<fC03 i1="12" i2="X" l="ENG"><s0>Treatment efficiency</s0>
<s5>12</s5>
</fC03>
<fC03 i1="12" i2="X" l="SPA"><s0>Eficacia tratamiento</s0>
<s5>12</s5>
</fC03>
<fC03 i1="13" i2="X" l="FRE"><s0>Courbe survie</s0>
<s5>13</s5>
</fC03>
<fC03 i1="13" i2="X" l="ENG"><s0>Survival curve</s0>
<s5>13</s5>
</fC03>
<fC03 i1="13" i2="X" l="SPA"><s0>Curva sobrevivencia</s0>
<s5>13</s5>
</fC03>
<fC03 i1="14" i2="X" l="FRE"><s0>Rétrospective</s0>
<s5>14</s5>
</fC03>
<fC03 i1="14" i2="X" l="ENG"><s0>Retrospective</s0>
<s5>14</s5>
</fC03>
<fC03 i1="14" i2="X" l="SPA"><s0>Retrospectiva</s0>
<s5>14</s5>
</fC03>
<fC07 i1="01" i2="X" l="FRE"><s0>Tumeur maligne</s0>
<s5>37</s5>
</fC07>
<fC07 i1="01" i2="X" l="ENG"><s0>Malignant tumor</s0>
<s5>37</s5>
</fC07>
<fC07 i1="01" i2="X" l="SPA"><s0>Tumor maligno</s0>
<s5>37</s5>
</fC07>
<fC07 i1="02" i2="X" l="FRE"><s0>Appareil circulatoire pathologie</s0>
<s5>61</s5>
</fC07>
<fC07 i1="02" i2="X" l="ENG"><s0>Cardiovascular disease</s0>
<s5>61</s5>
</fC07>
<fC07 i1="02" i2="X" l="SPA"><s0>Aparato circulatorio patología</s0>
<s5>61</s5>
</fC07>
<fC07 i1="03" i2="X" l="FRE"><s0>Lymphatique pathologie</s0>
<s5>62</s5>
</fC07>
<fC07 i1="03" i2="X" l="ENG"><s0>Lymphatic vessel disease</s0>
<s5>62</s5>
</fC07>
<fC07 i1="03" i2="X" l="SPA"><s0>Linfático patología</s0>
<s5>62</s5>
</fC07>
<fN21><s1>154</s1>
</fN21>
<fN82><s1>PSI</s1>
</fN82>
</pA>
</standard>
<server><NO>PASCAL 02-0266455 INIST</NO>
<ET>Adjuvant irradiation for axillary metastases from malignant melanoma</ET>
<AU>BALLO (Matthew T.); STROM (Eric A.); ZAGARS (Gunar K.); BEDIKIAN (Agop Y.); PRIETO (Victor G.); MANSFIELD (Paul F.); LEE (Jeffrey E.); GERSHENWALD (Jeffrey E.); ROSS (Merrick I.)</AU>
<AF>Department of Radiation Oncology, University of Texas M D. Anderson Cancer Center/Houston, TX/Etats-Unis (1 aut., 2 aut., 3 aut.); Department of Melanoma Medical Oncology, University of Texas M D. Anderson Cancer Center/Houston, TX/Etats-Unis (4 aut.); Department of Pathology, University of Texas M D. Anderson Cancer Center/Houston, TX/Etats-Unis (5 aut.); Department of Surgical Oncology, University of Texas M D. Anderson Cancer Center/Houston, TX/Etats-Unis (6 aut., 7 aut., 8 aut., 9 aut.)</AF>
<DT>Publication en série; Niveau analytique</DT>
<SO>International journal of radiation oncology, biology, physics; ISSN 0360-3016; Coden IOBPD3; Etats-Unis; Da. 2002; Vol. 52; No. 4; Pp. 964-972; Bibl. 23 ref.</SO>
<LA>Anglais</LA>
<EA>Purpose: To evaluate the outcome and treatment-related toxicity for patients with axillary lymph node metastases from malignant melanoma treated with surgery and radiation, with or without systemic therapy. Methods and Materials: The medical records of 89 consecutive patients with axillary lymph node metastases from malignant melanoma were retrospectively reviewed. All patients underwent axillary dissection and postoperative radiation to a median dose of 30 Gy at 6 Gy/fraction delivered twice weekly. In 3 patients referred with microscopic residual disease, a single boost (4-6 Gy) was given to a reduced field. All but 2 patients were referred because their axillary dissections revealed features believed to predict a 30-50% risk of subsequent axillary recurrence: lymph nodes ≥3 cm in size (54 patients), ≥4 lymph nodes positive (44), the presence of extracapsular extension (69), recurrent disease after initial surgical resection (23), or multiple risk factors (77). Fifty-one patients received systemic therapy before or after radiation therapy. Results: At a median follow-up of 63 months, 47 patients had relapsed and 43 patients had died. The actuarial overall and disease-free survival rates at 5 years were 50% and 46%, respectively. The actuarial axillary control and distant metastasis-free survival rates at 5 years were 87% and 49%, respectively. Univariate analysis revealed that the probability of axillary control was inferior when the axillary disease measured >6 cm in size (72% vs. 93%, p = 0.02), the location of the primary tumor was unknown (74% vs. 93%, p = 0.02), the axillary failure occurred within 18 months from diagnosis of the primary melanoma (84% vs. 100%, p = 0.04), or the Breslow thickness was >4 mm (80% vs. 96%, p = 0.04). Additionally, there was an inferior distant metastasis-free and disease-free survival when there were >2 nodes positive for metastatic disease, the primary lesion had a Breslow thickness >4 mm, or the axillary failure occurred within 18 months from diagnosis of the primary melanoma. On multivariate analysis, the significantly inferior distant metastasis-free and disease-free survival seen when >2 nodes were positive or the recurrence occurred within 18 months remained significant. The small number of axillary failures precluded multivariate analysis for axillary control; however, stratified analysis suggested that size >6 cm was the factor most closely associated with subsequent axillary failure. Twenty-six patients developed treatment-related arm edema. Classification according to the severity of edema yielded 5-year actuarial arm edema rates of 21%, 19%, and 1%, for Grade 1 (transient or asymptomatic), Grade 2 (requiring medical intervention), or Grade 3 (requiring surgical intervention) edema, respectively. Conclusion: Adjuvant radiation therapy using a hypofractionated regimen resulted in an 87% 5-year axillary control rate, superior to the 50-70% local control achieved with surgery alone for lymph node metastases from melanoma when high-risk features are present. Improvements are needed for patients with bulky nodal masses >6 cm in size. Mild-to-moderate arm edema was common, but manageable. The degree to which radiotherapy adds to the risk of arm edema after axillary dissection alone cannot be addressed in the present analysis.</EA>
<CC>002B04C; 002B04H02A</CC>
<FD>Mélanome malin; Homme; Métastase; Ganglion axillaire; Chirurgie; Traitement adjuvant; Radiothérapie; Dose fractionnée; Plan traitement; Lymphoedème; Radiolésion; Efficacité traitement; Courbe survie; Rétrospective</FD>
<FG>Tumeur maligne; Appareil circulatoire pathologie; Lymphatique pathologie</FG>
<ED>Malignant melanoma; Human; Metastasis; Axillary ganglion; Surgery; Adjuvant treatment; Radiotherapy; Fractionated dose; Treatment planning; Lymphedema; Radiation injury; Treatment efficiency; Survival curve; Retrospective</ED>
<EG>Malignant tumor; Cardiovascular disease; Lymphatic vessel disease</EG>
<SD>Melanoma maligno; Hombre; Metástasis; Ganglio axilar; Cirugía; Tratamiento adyuvante; Radioterapia; Dosis fraccionada; Plan tratamiento; Linfedema; Lesión por radiación; Eficacia tratamiento; Curva sobrevivencia; Retrospectiva</SD>
<LO>INIST-17180.354000100376130120</LO>
<ID>02-0266455</ID>
</server>
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