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Treatment of Clinically Positive Cervical Lymph Nodes by Limited Local Node Excision and Adjuvant Radiotherapy in Melanoma Patients with Major Comorbidities

  • Melanoma
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Abstract

Introduction

When cervical lymph nodes are clinically positive for metastatic melanoma, surgeons may be hesitant to recommend a therapeutic complete lymph node dissection if the patient is elderly or has major comorbidities. A limited local node excision of the clinically positive nodes only, followed by adjuvant radiotherapy to the entire node field, may be an effective alternative in such patients.

Methods

All patients who had presented with a primary head and neck melanoma or an unknown primary site and had subsequently undergone limited local node excision and adjuvant radiotherapy for macroscopically involved cervical nodes between 1993 and 2010 at a tertiary referral center were selected for study.

Results

Twenty-eight patients were identified, with a median age of 78 years and a median of 2 major comorbidities. The 5-year regional control, disease-free survival, and overall survival rates were 69%, 44%, and 50%, respectively. At the time of data analysis, seven patients were alive without evidence of disease. Twenty-one patients had died: 11 of melanoma (4 with neck recurrence) and 10 of other causes (2 with neck recurrence).

Conclusions

Excision of clinically positive metastatic cervical lymph nodes followed by radiotherapy provides satisfactory regional disease control without risking serious morbidity or mortality in melanoma patients whose general condition is considered a contraindication for therapeutic complete lymph node dissection.

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Funding

Funding was provided by Sydney Medical School Foundation.

Author information

Authors and Affiliations

  1. Melanoma Institute Australia, The University of Sydney, Sydney, NSW, Australia

    Hidde M. Kroon MD, PhD, Wendy D. van der Bol MD, Angela M. Hong MBBS, PhD, FRANZCR, George Hruby MBChB, FRANZCR & John F. Thompson MD, FRACS, FACS

  2. Garvan Institute of Medical Research, Darlinghurst, NSW, Australia

    Katherine T. Tonks MBBS, FRACP

  3. Department of Radiation Oncology, Royal Prince Alfred Hospital, Camperdown, NSW, Australia

    Angela M. Hong MBBS, PhD, FRANZCR & George Hruby MBChB, FRANZCR

  4. Department of Melanoma and Surgical Oncology, Royal Prince Alfred Hospital, Camperdown, NSW, Australia

    John F. Thompson MD, FRACS, FACS

Authors
  1. Hidde M. Kroon MD, PhD
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  2. Wendy D. van der Bol MD
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  3. Katherine T. Tonks MBBS, FRACP
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  4. Angela M. Hong MBBS, PhD, FRANZCR
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  5. George Hruby MBChB, FRANZCR
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  6. John F. Thompson MD, FRACS, FACS
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Corresponding author

Correspondence to John F. Thompson MD, FRACS, FACS.

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Kroon, H.M., van der Bol, W.D., Tonks, K.T. et al. Treatment of Clinically Positive Cervical Lymph Nodes by Limited Local Node Excision and Adjuvant Radiotherapy in Melanoma Patients with Major Comorbidities. Ann Surg Oncol 25, 3476–3482 (2018). https://doi.org/10.1245/s10434-018-6692-2

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  • DOI: https://doi.org/10.1245/s10434-018-6692-2

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