Adjuvant postoperative radiotherapy to the cervical lymph nodes in cutaneous melanoma: is there any benefit for high-risk patients?

Abstract

The use of adjuvant radiotherapy after lymph node dissection for metastatic melanoma remains controversial. This study examined the effectiveness of adjuvant radiotherapy in controlling regional disease in high-risk patients. A total of 716 patients were identified from a large prospective database who underwent cervical lymph node surgery between 1990 and 2004. Patients with high-risk disease were offered radiotherapy (n = 129), and this group was compared with the group of patients who did not receive radiotherapy (n = 587) in the same period. Radiotherapy did not improve regional control in patients who had metastatic melanoma of the cervical lymph nodes (P = .2). There were 10% fewer regional recurrences in patients with extracapsular spread who received adjuvant radiotherapy, although this was not statistically significant (P = .34). Adjuvant radiotherapy conferred no overall survival benefit to patients with nodal metastases (P = .39). There was a statistically significant trend for worse survival with increasing nodal tumor burden that remained unchanged with adjuvant radiotherapy. This large, nonrandomized retrospective study found no evidence to support the use of adjuvant radiotherapy for high-risk melanoma. A multicenter randomized, controlled trial investigating this important clinical dilemma is advocated.