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• W2141264421 abstract "With great interest we read the article published by Lee et al. ( 1 Lee R.J Gibbs J.F Prouix G.M Kollmorgen D.R Jia C Kraybill W.G Nodal basin recurrence following lymph node dissection for melanoma Implications for adjuvant radiotherapy. Int J Radiat Oncol Biol Phys. 2000; 46: 467-474 Abstract Full Text Full Text PDF PubMed Scopus (142) Google Scholar ) in the January issue of this journal. The authors report a 36% local failure rate after the decision of clinically involved lymph nodes in malignant melanoma and conclude that these patients should be considered for adjuvant radiotherapy to the lymph node basin. To design a study on this issue, several additional aspects deserve further consideration. Clearly, local disease control is of great importance in metastasized melanoma, as cutaneous ulceration, lymph edema, disfigurement, and pain impair considerably the quality of life of these patients. In our own patient population, consisting of 224 consecutive patients with palpable metastases of the groin or the axilla, the 5-year local recurrence rate was as high as that observed by Lee et al. (34.4%). Recognizing this problem in 1988, we introduced operative procedures according to reported standard techniques ( 2 Harris NM. Axillary lymph node dissection. In: McKie RM, editor. Surgical approaches to cutaneous melanoma. Pigment Cell. Basel: Karger; 1985; p. 105–120. Google Scholar , 3 Storm FK, Eilber FR, Moseley HS; et al. Radical groin dissection. In: McKie RM, editor. Surgical approaches to cutaneous melanoma. Pigment Cell. Basel: Karger; 1985. p. 121–130. Google Scholar ). Although this led to a significantly improved local control rate for the dissected axilla (p = 0.0008), no improvement of local control was achieved for the groin (Table 1). Despite the clearly improved local control of the axillary basin, there was no difference in survival between the patient groups submitted to the different surgical procedures. Moreover, in previous articles ( 4 Kretschmer L Lautenschläger C.H Preußer K.-P et al. Axillary recurrence following lymph-node dissection in malignant melanoma. Langenbecks Arch Surg. 1993; 378: 4-11 Google Scholar , 5 Kretschmer L, Lautenschläger, Ch, Preußer K-P; et al. Groin recurrence following therapeutic lymph-node dissection in malignant melanoma. Langenbecks Arch Surg 1993;378:211–216. Google Scholar ) we had pointed out a significant coincidence of in-transit metastases and recurrence in the dissected nodal basin. The 5-year probability of in-transit metastases in our patients with recurrent disease in the lymphadenectomy area was 61.5%, compared to a 18.9% probability of in-transit metastases in those patients in whom the lymphadenectomy region remained disease free. As 31 out of 62 patients with recurrence in the dissected nodal basin suffered from in-transit metastases (in 15 cases, in-transit metastases manifested before the appearance of local recurrence), tumor cells, which are still en route to the lymph-node basin at the time of lymphadenectomy, might cause recurrences in the lymph node region later on. Thus, it might be advisable to apply adjuvant irradiation not only to the nodal basin but also to the in-transit region whenever possible. Clearly, for future studies evaluating the benefit of this type of adjuvant therapy, standardized operative procedures are mandatory. Also, because the application of adequate surgical procedures, although improving local control, is not followed by prolonged survival, long-term morbidity deserves careful consideration when adjuvant irradiation therapy is undertaken. Table 1Influence of standardized operative procedures on local recurrence Site of Dissection 5-year relapse rates for the dissected nodal basin (Kaplan–Meier Estimates) P (by log–rank test) Control group July 1983–June 1988 Standardized dissection July 1988–September 1994 Axillary dissection 41.3% (n = 57) 13.1% (n = 63) 0.0008 Groin dissection 41.3% (n = 46) 40.7% (n = 58) NS All patients 42.1% (n = 103) 27.4% (n = 121) 0.0267 Open table in a new tab" @default.
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• W2141264421 title "In regard to: Lee RJ, et al. Nodal basin recurrence following lymph node dissection for melanoma: implications for adjuvant radiotherapy. INT J. Radiat Oncol Biol Phys 2000;46:467–474." @default.
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• W2141264421 doi "https://doi.org/10.1016/s0360-3016(00)00740-9" @default.
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