Roles of adjuvant and salvage radiotherapy for desmoplastic melanoma

• Type of Material: Article
• Authors: Daniel Oliver, Emory University; Kirtesh R. Patel, Emory University; Jeffrey Switchenko, Emory University; Douglas Parker, Emory University; David Lawson, Emory University; Keith Delman, Emory University; Ragini Kudchadkar, Emory University; Mohammad Khan, Emory University
• Language: English
• Date: 2016-02-01
• Publisher: Lippincott, Williams & Wilkins
• Publication Version: Author Accepted Manuscript (After Peer Review)
• Copyright Statement: © 2016 Wolters Kluwer Health, Inc. All rights reserved.
• Final Published Version (URL): http://dx.doi.org/10.1097/CMR.0000000000000201
• Title of Journal or Parent Work: Melanoma Research
• ISSN: 0960-8931
• Volume: 26
• Issue: 1
• Start Page: 35
• End Page: 41
• Grant/Funding Information: Research reported in this publication was supported in part by the Biostatistics and Bioinformatics Shared Resource of Winship Cancer Institute of Emory University and NIH/NCI under award number P30CA138292.
• Keywords: salvage; Oncology; RADIATION; control; regional; CLINICOPATHOLOGICAL ANALYSIS; radiation; Research & Experimental Medicine; PROGNOSTIC-FACTORS; CUTANEOUS MELANOMA; desmoplastic; prognostic factors; melanoma; Science & Technology; Life Sciences & Biomedicine; Dermatology; MALIGNANT-MELANOMA; local recurrence; NEUROTROPIC MELANOMA; radiotherapy; risk factors
• Research Categories: Health Sciences, Pathology; Health Sciences, Oncology

Abstract

Current guidelines are unclear as to the precise role of radiotherapy (RT) in patients with desmoplastic melanoma (DM). The purpose of this study was to evaluate our institutional outcomes in patients with DM, and to explore the roles of both adjuvant and salvage RT in these patients. We identified 100 patients with a histopathologic diagnosis of DM who received treatment at our institution from 2000 to 2014. Local control, distant metastasis-free survival, and overall survival (OS) were evaluated in the 95 patients managed surgically with or without adjuvant and/or salvage RT. The overall rate of local recurrence (LR) was 10%. There was no LR in either adjuvant or salvage RT cohort. Adjuvant RT did not significantly improve LR-free survival at 5 years (100 vs. 81%, P=0.59), despite the RTpatients having worse pathological features. Four of seven (57%) salvage patients developed distant metastases, despite 100% local control. Adjuvant RT did not significantly impact 5-year overall survival (86 vs. 82%, P=0.43). RT shows a trend towards improved local control in both the adjuvant and salvage settings for patients with DM, and likely overcomes adverse risk factors after surgery in appropriately selected patients. Future prospective studies are needed to better address the optimal management for these patients.