The Benefits of Adjuvant. Radiation Therapy After Therapeutic Lymphadenectomy for Clinically Advanced, High-Risk, Lymph Node-Metastatic Melanoma
The Benefits of Adjuvant. Radiation Therapy After Therapeutic Lymphadenectomy for Clinically Advanced, High-Risk, Lymph Node-Metastatic Melanoma
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DOI：
10.1002/cncr.24627
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发表时间：
2009-12-15
期刊：
影响因子：
6.2
通讯作者：
Ballo, Matthew T.
中科院分区：
文献类型：
--
作者：
Agrawal, Shefali;Kane, John M., III;Ballo, Matthew T.
背景：本研究的目的是评价辅助放射治疗(RT)对临床晚期转移性黑色素瘤淋巴清扫(TL)后局部复发和生存的影响。方法：对615例临床晚期区域淋巴结转移性疾病的患者行TL术。所有患者都适合接受辅助放疗(增大或多发阳性淋巴结，包膜外延伸)，因为无论他们是否接受放疗，区域复发的风险都很高。分析了患者相关变量、肿瘤相关变量和治疗相关变量，这些变量与放疗前后的复发、存活率和治疗相关发病率有关。结果：中位随访时间为5年。精算5年区域淋巴结盆控制率为81%。在多变量分析中，阳性淋巴结的数量、淋巴结切除的数量和辅助RT的使用与区域控制的改善相关。与治疗相关的发病率，特别是淋巴水肿，随着辅助RT的使用和腹股沟淋巴结转移部位的增加而增加。随访268例，5年无远处转移生存率(DMFS)为40%，疾病特异性生存率(DSS)为48%。在多因素分析中，DMFS和DSS均受阳性淋巴结数目和淋巴结清扫数目的影响。此外，DSS还受原发灶厚度和接受辅助性放疗的影响。结论：在高危、临床晚期、淋巴结转移性黑色素瘤患者中，与单纯TL相比，辅助性RT可改善区域淋巴盆腔控制。虽然这是一种局部治疗，但辅助RT也可能对DSS产生影响。癌症杂志2009；115：5836-44。(C)2009年美国癌症协会。
BACKGROUND: The objective of this study was to evaluate the impact of adjuvant radiation therapy (RT) on regional recurrence and survival after therapeutic lymphadenectomy (TL) for clinically advanced, lymph node-metastatic melanoma. METHODS: Six hundred fifteen patients who had clinically advanced, regional lymph node-metastatic disease underwent TL. All patients were appropriate potential candidates for adjuvant RT (enlarged or multiple positive lymph nodes, extracapsular extension) because of a high risk for regional recurrence regardless of whether or not they received RT. Patient-related, tumor-related, and treatment-related variables that were associated with recurrence, survival, and treatment-related morbidity with and without RT were analyzed. RESULTS: The median follow-up was 5 years. The actuarial 5-year regional lymph node basin control rate was 81%. On multivariate analysis, the number of positive lymph nodes, the number of lymph nodes removed, and the use of adjuvant RT were associated with improved regional control. Treatment-related morbidity, particularly lymphedema, was increased with the use of adjuvant RT and an inguinal site of lymph node metastases. At last follow-up, 268 patients were alive with actuarial 5-year distant metastasis-free survival (DMFS) and disease-specific survival (DSS) rates of 40% and 48%, respectively. On multivariate analysis, DMFS and DSS both were influenced by the number of positive lymph nodes and the number of lymph nodes removed. In addition, DSS was influenced by primary tumor thickness and the receipt of adjuvant RT. CONCLUSIONS: Adjuvant RT was associated with improved regional lymph node basin control compared with TL alone in patients with high-risk, clinically advanced, lymph node-metastatic melanoma. Although it is a regional therapy, adjuvant RT also may have an impact on DSS. Cancer 2009;115:5836-44. (C) 2009 American Cancer Society.