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Regional Radiation Therapy Impacts Outcome for Node-Positive Cutaneous Melanoma.
- Source :
-
Journal of the National Comprehensive Cancer Network : JNCCN [J Natl Compr Canc Netw] 2017 Apr; Vol. 15 (4), pp. 473-482. - Publication Year :
- 2017
-
Abstract
- Background: Regional radiation therapy (RT) has been shown to reduce the risk of regional recurrence with node-positive cutaneous melanoma. However, risk factors for regional recurrence, especially in the era of sentinel lymph node biopsy (SLNB), are less clear. Our goals were to identify risk factors associated with regional recurrence and to determine whether a radiosensitivity index (RSI) gene expression signature (GES) could identify patients who experience a survival benefit with regional RT. Methods: A single-institution, Institutional Review Board-approved study was performed including 410 patients treated with either SLNB with or without completion lymph node dissection (LND; n=270) or therapeutic LND (n=91). Postoperative regional RT was delivered to the involved nodal basin in 83 cases (20.2%), to a median dose of 54 Gy (range, 30-60 Gy) in 27 fractions (range, 5-30). Primary outcomes were regional control and overall survival by RSI GES status. Results: Median follow-up was 69 months (range, 13-180). Postoperative regional RT was associated with a reduced risk of regional recurrence among all patients on univariate (5-year estimate: 95.0% vs 83.3%; P =.036) and multivariate analysis (hazard ratio[HR], 0.15; 95% CI, 0.05-0.43; P <.001). Among higher-risk subgroups, regional RT was associated with a lower risk of regional recurrence among patients with clinically detected lymph nodes (n=175; 5-year regional control: 94.1% vs 69.5%; P =.003) and extracapsular extension (ECE) present (n=138; 5-year regional control: 96.7% vs 62.2%; P <.001). Among a subset of radiated patients with gene expression data available, a low RSI GES (radiosensitive) tumor status was associated with improved survival compared with a high RSI GES (5-year: 75% vs 0%; HR, 10.68; 95% CI, 1.24-92.14). Conclusions: Regional RT was associated with a reduced risk of regional recurrence among patients with ECE and clinically detected nodal disease. Gene expression data show promise for better predicting radiocurable patients in the future. In the era of increasingly effective systemic therapies, the value of improved regional control potentially takes on greater significance.<br /> (Copyright © 2017 by the National Comprehensive Cancer Network.)
- Subjects :
- Adolescent
Adult
Aged
Aged, 80 and over
Biomarkers, Tumor
Cohort Studies
Combined Modality Therapy
Female
Follow-Up Studies
Gene Expression Profiling methods
Humans
Kaplan-Meier Estimate
Lymphatic Metastasis
Male
Melanoma genetics
Melanoma mortality
Middle Aged
Neoplasm Recurrence, Local
Radiotherapy, Adjuvant methods
Retreatment
Skin Neoplasms genetics
Skin Neoplasms mortality
Treatment Failure
Treatment Outcome
Young Adult
Melanoma, Cutaneous Malignant
Melanoma pathology
Melanoma radiotherapy
Skin Neoplasms pathology
Skin Neoplasms radiotherapy
Subjects
Details
- Language :
- English
- ISSN :
- 1540-1413
- Volume :
- 15
- Issue :
- 4
- Database :
- MEDLINE
- Journal :
- Journal of the National Comprehensive Cancer Network : JNCCN
- Publication Type :
- Academic Journal
- Accession number :
- 28404758
- Full Text :
- https://doi.org/10.6004/jnccn.2017.0047