Surgery and adjuvant radiotherapy for cutaneous melanoma considered high-risk for local-regional recurrence

Purpose: To assess the efficacy of postoperative radiotherapy (RT) in the treatment of cutaneous melanoma. Materials: Between August 1981 and December 2009, 82 patients were treated with surgery and postoperative RT for cutaneous melanoma. Patients were thought to be high risk for local regional recurrence after surgery alone because of the presence of one or more risk factors including recurrence after prior surgery, positive lymph nodes, extracapsular extension, incomplete regional node dissection, microscopically positive margins, gross residual disease, and in-transit metastases. The primary site was located in the head and neck in 64 patients and elsewhere in the remainder. Forty-two patients (47%) were treated with hypofractionated RT and the remainder with conventional fractionation. Median age was 62 years (range, 21 to >89 years). Median follow-up overall and for survivors was 3.0 years (range, 0.1 to 17.4 years) and 6.4 years (1.6 to 17.4 years), respectively. Results: The 5-year outcomes were: in-field local regional control 82%; local regional control, 76%; distant metastasis-free survival, 48%; cause-specific survival, 56%; and overall survival, 43%. In-field local regional control at 5 years was 87% after hypofractionated RT and 78% after conventionally fractionated RT. Conclusions: Postoperative adjuvant RT likely reduces the risk of local regional recurrence after surgery for patients with high risk cutaneous melanoma. Hypofractionated RT is as effective as conventional fractionation and is logistically advantageous, particularly for patients with a relatively poor prognosis. The risk of RT complications is low. (C) 2013 Elsevier Inc. All rights reserved.