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An innovative approach for locally advanced stage III cutaneous melanoma: radiotherapy, followed by nodal dissection.
MedLine Citation:
PMID:  22547205     Owner:  NLM     Status:  Publisher    
Abstract/OtherAbstract:
Patients with advanced nodal melanoma are typically managed with a regional nodal dissection; however, they have a high rate of distant relapse after surgery. This study assesses the role of preoperative radiotherapy to assist with the regional control in this subset of patients. Patients who had histologically confirmed stage III malignant melanoma and were treated with preoperative radiotherapy between 2004 and 2011 were eligible. All patients were staged with computer tomography and most with [F]-fluorodeoxyglucose (FDG) PET. Patients received preoperative radiotherapy, followed by a planned regional dissection at 12-14 weeks from completion with assessment of clinical, radiological and pathological responses. The primary outcome measure was the 1-year actuarial in-field control. There were 12 patients, with nine having disease of the axilla. All patients received radiotherapy up to a median dose of 48 Gy in 20 fractions, with seven patients achieving a partial clinical response. Ten patients proceeded to surgery, with four patients developing minor wound complications. The FDG-PET response did not appear to correlate with the pathological response. The 1-year in-field control rate was 92% (95% confidence interval 54-99) and the 1-year relapse-free survival was 54% (95% confidence interval 21-78). For selected patients with high-volume regional disease, we have successfully used preoperative radiotherapy, followed by a nodal dissection. Whether this type of protocol is of value in a more general group of patients with high-volume regional disease is currently under investigation.
Authors:
Matthew Foote; Bryan Burmeister; Patrick Dwyer; Elizabeth Burmeister; Duncan Lambie; Christopher Allan; Andrew Barbour; Gerard Bayley; Andrew Pullar; Janelle Meakin; Janine Thomas; Mark Smithers
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Publication Detail:
Type:  JOURNAL ARTICLE    
Journal Detail:
Title:  Melanoma research     Volume:  22     ISSN:  1473-5636     ISO Abbreviation:  -     Publication Date:  2012 Jun 
Date Detail:
Created Date:  2012-5-1     Completed Date:  -     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  9109623     Medline TA:  Melanoma Res     Country:  -    
Other Details:
Languages:  ENG     Pagination:  257-262     Citation Subset:  -    
Affiliation:
aDepartment of Radiation Oncology bDepartment of Surgery cQueensland Melanoma Project, Department of Surgery dDepartment of Pathology Queensland, Diamantina Institute, University of Queensland eQueensland Melanoma Project fDepartment of Radiation Oncology, Queensland University of Technology gNursing Practice Development Unit, Research Center for Clinical and Community Practice Innovation, Griffith University hClinical Trials Research Unit iDepartment of Plastic and Reconstructive Surgery, Princess Alexandra Hospital jDivision of Surgery, University of Queensland, Mater Adult Hospital, Brisbane, Australia.
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