A prospective phase II study of adjuvant postoperative radiation therapy following nodal surgery in malignant melanoma–Trans Tasman Radiation Oncology Group (TROG) Study 96.06

Burmeister, Bryan H.; Mark Smithers, B.; Burmeister, Elizabeth; Baumann, Kathryn; Davis, Sidney; Krawitz, Hedley; Johnson, Carol; Spry, Nigel

doi:10.1016/j.radonc.2006.10.001

« Previous Next »Radiotherapy & Oncology
Volume 81, Issue 2 , Pages 136-142, November 2006

A prospective phase II study of adjuvant postoperative radiation therapy following nodal surgery in malignant melanoma–Trans Tasman Radiation Oncology Group (TROG) Study 96.06☆

Bryan H. Burmeister
- University of Queensland, Melanoma Clinic, Princess Alexandra Hospital, Brisbane, Australia
- Corresponding author. Bryan H. Burmeister, University of Queensland, Princess Alexandra Hospital, Woolloongabba 4102, Australia.
B. Mark Smithers
- University of Queensland, Melanoma Clinic, Princess Alexandra Hospital, Brisbane, Australia
Elizabeth Burmeister
- Queensland Cancer Control Analysis Team, Brisbane, Australia
Kathryn Baumann
- Radiation Oncology Mater Centre, Brisbane, Australia
Sidney Davis
- William Buckland Radiotherapy Centre, Melbourne, Australia
Hedley Krawitz
- Auckland Hospital, Auckland, New Zealand
Carol Johnson
- Wellington Hospital, Wellington, New Zealand
Nigel Spry
- Sir Charles Gairdner Hospital, Perth, Australia

Received 24 May 2006; received in revised form 25 September 2006; accepted 2 October 2006. published online 25 October 2006.

Abstract

Background

The role of adjuvant postoperative therapy after resection of localised malignant melanoma involving regional lymph nodes remains controversial. There are no randomised trials that confirm that postoperative radiation conveys a benefit in terms of regional control or survival.

Methods

Two hundred and thirty-four patients with melanoma involving lymph nodes were registered on a prospective study to evaluate the effect of postoperative radiation therapy. The regimen consisted of 48Gy in 20 fractions to the nodal basin using recommended treatment guidelines for each of the major node sites. The primary endpoints were regional in-field relapse and late toxicity. Secondary endpoints were adjacent relapse, distant relapse, overall survival, progression-free survival and time to in-field progression.

Results

Adjuvant radiation therapy was well tolerated by all of the patients. As the first site of relapse, regional in-field relapses occurred in 16/234 patients (6.8%). The overall survival was 36% at 5 years. The progression-free survival and regional control rates were 27% and 91%, respectively, at 5 years. Patients with more than 2 nodes involved had a significantly worse outcome in terms of distant relapse, overall and progression-free survival.

Conclusion

We believe that adjuvant radiation therapy following nodal surgery could offer a possible benefit in terms of regional control. These results require confirmation in a randomised trial.

Keywords: Melanoma, Radiation therapy, Nodal disease, Regional relapse