The role of adjuvant radiotherapy in the local management of desmoplastic melanoma
Menée à partir de données portant sur 130 patients atteints d'un mélanome desmoplastique non métastatique diagnostiqué entre 1985 et 2009 (âge : 21 à 97 ans, durée médiane de suivi : 6,6 ans), cette étude rétrospective évalue, du point de vue des taux de survie spécifique, de survie globale et de récidive locale à 5 et 10 ans, l'intérêt d'une radiothérapie après une intervention chirurgicale
BACKGROUND : In the current study, the authors sought to evaluate outcomes, specifically with respect to adjuvant radiotherapy (RT), for patients with desmoplastic melanoma. METHODS : The records of 130 consecutive patients who presented between 1985 and 2009 with nonmetastatic desmoplastic melanoma and were treated curatively with either surgery alone (59 patients; 45%) or surgery and postoperative RT (71 patients; 55%) were retrospectively reviewed. Ages ranged from 21 years to 97 years (median age, 66 years). The location of the primary tumor was in the head and neck region in 62% of patients. Only 5 patients (4%) had lymph node involvement at the time of presentation. RESULTS : The median follow-up was 6.6 years (range, 11 months-24 years). Overall survival rates at 5 years and 10 years were 69% and 53%, respectively. Disease-specific survival rates were 84% and 80%, respectively, at 5 years and 10 years. The actuarial rate of local recurrence was 17% at 5 years and beyond. Of the patients who underwent surgery without receiving postoperative RT, 14 (24%) experienced local recurrence. Of the 71 patients treated with surgery and postoperative RT, 5 (7%) experienced local recurrence. In a Cox multivariate regression model, improved local control was significantly associated with the receipt of postoperative RT (P = .009). CONCLUSIONS : Surgery followed by postoperative RT appears to provide superior local control compared with surgery alone for patients with desmoplastic melanoma.