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Adjuvant Radiation Therapy for Clinical Stage III Melanoma in the Modern Therapeutic Era.

Publication ,  Journal Article
Straker, RJ; Song, Y; Sun, J; Shannon, AB; Cohen, LS; Muradova, E; Daou, H; Krause, K; Li, S; Frederick, DT; Rhodin, KE; Brizel, DM; Lin, A ...
Published in: Annals of surgical oncology
July 2021

Adjuvant radiation therapy (RT) can decrease lymph node basin (LNB) recurrences in patients with clinically evident melanoma lymph node (LN) metastases following lymphadenectomy, but its role in the era of modern systemic therapies (ST), immune checkpoint or BRAF/MEK inhibitors, is unclear.Patients at four institutions who underwent lymphadenectomy (1/1/2010-12/31/2019) for clinically evident melanoma LN metastases and received neoadjuvant and/or adjuvant ST with RT, or ST alone, but met indications for RT, were identified. Comparisons were made between ST alone and ST/RT groups. The primary outcome was 3-year cumulative incidence (CI) of LNB recurrence. Secondary outcomes included 3-year incidences of in-transit/distant recurrence and survival estimates.Of 98 patients, 76 received ST alone and 22 received ST/RT. Median follow-up time for patients alive at last follow-up was 44.6 months. The ST/RT group had fewer inguinal node metastases (ST 36.8% versus ST/RT 9.1%; P = 0.04), and more extranodal extension (ST 50% versus ST/RT 77.3%; P = 0.02) and positive lymphadenectomy margins (ST 2.6% versus ST/RT 13.6%; P = 0.04). The 3-year CI of LNB recurrences was lower for the ST/RT group compared with the ST group (13.9% versus 25.2%), but this reduction was not statistically significant (P = 0.36). Groups did not differ significantly in in-transit/distant recurrences (P = 0.24), disease-free survival (P = 0.14), or melanoma-specific survival (P = 0.20).In the era of modern ST, RT may still have value in reducing LNB recurrences in melanoma with clinical LN metastases. Further research should focus on whether select patient populations derive benefit from combination therapy, and optimizing indications for RT following neoadjuvant ST.

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Published In

Annals of surgical oncology

DOI

EISSN

1534-4681

ISSN

1068-9265

Publication Date

July 2021

Volume

28

Issue

7

Start / End Page

3512 / 3521

Related Subject Headings

  • Skin Neoplasms
  • Radiotherapy, Adjuvant
  • Oncology & Carcinogenesis
  • Neoplasm Staging
  • Neoplasm Recurrence, Local
  • Melanoma
  • Lymph Node Excision
  • Humans
  • 3211 Oncology and carcinogenesis
  • 1112 Oncology and Carcinogenesis
 

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Straker, R. J., Song, Y., Sun, J., Shannon, A. B., Cohen, L. S., Muradova, E., … Karakousis, G. C. (2021). Adjuvant Radiation Therapy for Clinical Stage III Melanoma in the Modern Therapeutic Era. Annals of Surgical Oncology, 28(7), 3512–3521. https://doi.org/10.1245/s10434-020-09384-8
Straker, Richard J., Yun Song, James Sun, Adrienne B. Shannon, Leah S. Cohen, Elnara Muradova, Hala Daou, et al. “Adjuvant Radiation Therapy for Clinical Stage III Melanoma in the Modern Therapeutic Era.Annals of Surgical Oncology 28, no. 7 (July 2021): 3512–21. https://doi.org/10.1245/s10434-020-09384-8.
Straker RJ, Song Y, Sun J, Shannon AB, Cohen LS, Muradova E, et al. Adjuvant Radiation Therapy for Clinical Stage III Melanoma in the Modern Therapeutic Era. Annals of surgical oncology. 2021 Jul;28(7):3512–21.
Straker, Richard J., et al. “Adjuvant Radiation Therapy for Clinical Stage III Melanoma in the Modern Therapeutic Era.Annals of Surgical Oncology, vol. 28, no. 7, July 2021, pp. 3512–21. Epmc, doi:10.1245/s10434-020-09384-8.
Straker RJ, Song Y, Sun J, Shannon AB, Cohen LS, Muradova E, Daou H, Krause K, Li S, Frederick DT, Rhodin KE, Brizel DM, Boland GM, Beasley GM, Wuthrick EJ, Sondak VK, Zager JS, Lin A, Lukens JN, Karakousis GC. Adjuvant Radiation Therapy for Clinical Stage III Melanoma in the Modern Therapeutic Era. Annals of surgical oncology. 2021 Jul;28(7):3512–3521.
Journal cover image

Published In

Annals of surgical oncology

DOI

EISSN

1534-4681

ISSN

1068-9265

Publication Date

July 2021

Volume

28

Issue

7

Start / End Page

3512 / 3521

Related Subject Headings

  • Skin Neoplasms
  • Radiotherapy, Adjuvant
  • Oncology & Carcinogenesis
  • Neoplasm Staging
  • Neoplasm Recurrence, Local
  • Melanoma
  • Lymph Node Excision
  • Humans
  • 3211 Oncology and carcinogenesis
  • 1112 Oncology and Carcinogenesis