Elective radiotherapy provides regional control for patients with cutaneous melanoma of the head and neck
Elective radiotherapy provides regional control for patients with cutaneous melanoma of the head and neck
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作者：
Bonnen, MD;Ballo, MT;Ang, KK
背景资料。在目前的研究中，作者评估了选择性放射治疗在头颈部皮肤黑色素瘤患者中提供区域(淋巴结)控制的有效性，这些患者是淋巴结受累的高危人群。方法：从1983年到1998年，157例头颈部皮肤黑色素瘤患者在广泛切除原发灶后接受了选择性区域放射治疗。所有患者均未接受前哨淋巴结活检或淋巴结清扫术。对他们的病历进行回顾和结果分析。结果：本次回顾的中位随访期为68个月(范围为7-185个月)。局部复发9例，颈淋巴结复发15例，远处复发57例。5年和10年的精算区域控制率均为%。5年的疾病特异性生存率和无远处转移生存率分别为68%和63%，10年分别为58%和49%。Breslow厚度是疾病特异性存活率和无远处转移存活率的重要决定因素。10年后，6%的患者出现了与症状治疗相关的并发症。没有与治疗相关的死亡。结论：本研究的结果证实了选择性区域放射治疗对预计有较高淋巴结转移率的皮肤头颈部黑色素瘤患者的有效性和安全性。选择性放疗是选择性淋巴清扫术的一种可行的替代方案。它也可以作为前哨淋巴结活检的替代方法，特别是对于那些不能进行清扫和全身治疗的患者。(C)2003年美国癌症协会。
BACKGROUND. In the current study, the authors assessed the efficacy of elective radiotherapy in providing regional (lymph node) control in patients with cutaneous melanoma of the head and neck who were at high risk for lymph node involvement. Toxicity was also assessed.METHODS. From 1983 to 1998, 157 patients with Stage I or II cutaneous melanoma of the head and neck received elective regional radiotherapy after wide local excision of the primary lesion. None of the patients had received sentinel lymph node biopsy or dissection of the lymph nodes. Their medical records were reviewed retrospectively and analyzed for outcome.RESULTS. The median follow-up for the current review was 68 months (range, 7-185 months). The disease recurred locally in 9 patients, in the neck lymph nodes in 15 patients, and distantly in 57 patients. The actuarial regional control rate was 89% at both 5 years and 10 years. The actuarial disease-specific survival and distant metastasis-free survival rates were 68% and 63%, respectively, at 5 years and 58% and 49%, respectively, at 10 years. Breslow thickness was a significant determinant of disease-specific survival and distant metastasis-free survival rates. At 10 years, 6% of patients had developed a symptomatic treatment-related complication. There were no treatment-related deaths.CONCLUSIONS. The results of the current study confirmed the efficacy and safety of elective regional radiotherapy for patients with cutaneous head and neck melanoma predicted to have a high rate of lymph node involvement. Elective irradiation was a viable alternative to elective lymph node dissection. It may also serve as an alternative to sentinel lymph node biopsy, particularly for patients for whom dissection and systemic therapy are not therapeutic options. (C) 2003 American Cancer Society.