Radiation therapy following nodal surgery for melanoma: An analysis of late toxicity

Burmeister, Bryan; Smithers, B. Mark; Davis, Sally J.; Spry, Nigel; Johnson, Carol; Krawitz, Hedley; Baumann, Kathryn

doi:10.1046/j.1445-2197.2002.02405.x

Cited by 54 publications

(34 citation statements)

References 22 publications

(39 reference statements)

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“…Melanoma patients were then stratified into 2 groups according to the anatomic region in which lymph node dissection was performed (ie, axillary and inguinofemoral). Six studies included both patients who had undergone axillary or inguinofemoral lymph node dissections, [16][17][18][19][20][21] ; the dissection groups from these studies are listed separately in Table 1. The pooled incidence of lower extremity lymphedema after inguinofemoral lymph node dissection was higher (18%) than for upper extremity lymphedema after axillary lymph node dissection (3%).…”

Section: Type Of Malignancymentioning

confidence: 99%

Lymphedema beyond breast cancer

Cormier

Askew

Mungovan

et al. 2010

Cancer

398

170

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BACKGROUND: Secondary lymphedema is a debilitating, chronic, progressive condition that commonly occurs after the treatment of breast cancer. The purpose of the current study was to perform a systematic review and meta-analysis of the oncology-related literature excluding breast cancer to derive estimates of lymphedema incidence and to identify potential risk factors among various malignancies. METHODS: The authors systematically reviewed 3 major medical indices (MEDLINE, Cochrane Library databases, and Scopus) to identify studies that included a prospective assessment of lymphedema after cancer treatment. Studies were categorized according to malignancy, and data included treatment, complications, lymphedema measurement criteria, lymphedema incidence, and followup interval. A quality assessment of individual studies was performed using established criteria for systematic reviews. Bayesian meta-analytic techniques were applied to derive summary estimates when sufficient data were available. RESULTS: A total of 47 studies (7779 cancer survivors) met inclusion criteria: melanoma (n ¼ 15), gynecologic malignancies (n ¼ 22), genitourinary cancers (n ¼ 8), head/neck cancers (n ¼ 1), and sarcomas (n ¼ 1). The overall incidence of lymphedema was 15.5% and varied by malignancy (P < .001): melanoma, 16% (upper extremity, 5%; lower extremity, 28%); gynecologic, 20%; genitourinary, 10%; head/neck, 4%; and sarcoma, 30%. Increased lymphedema risk was also noted for patients undergoing pelvic dissections (22%) and radiation therapy (31%). Objective measurement methods and longer follow-up were both associated with increased lymphedema incidence. CONCLUSIONS: Lymphedema is a common condition affecting cancer survivors with various malignancies. The incidence of lymphedema is related to the type and extent of treatment, anatomic location, heterogeneity of assessment methods, and length of follow-up. Cancer 2010;116:5138-49.

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Section: Type Of Malignancymentioning

confidence: 99%

Lymphedema beyond breast cancer

Cormier

Askew

Mungovan

et al. 2010

Cancer

398

170

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“…• Hypofractionated radiotherapy is well tolerated [29,30,35,48]. No grade-3 toxicity was reported by Bello et al [35] in 148 patients treated with 30 Gy in 5 fractions.…”

Section: Dose and Fractionationmentioning

confidence: 95%

Melanoma of the head and neck

Day

Hornig²,

Sharma³

et al. 2005

Curr. Treat. Options in Oncol.

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Staging of cutaneous melanoma has changed in recent years with an increased emphasis upon thickness and ulceration on prognosis of early stage disease. Cutaneous melanoma of the head and neck is treated with complete surgical resection in early stage disease. Resection margins are determined by the size, depth, and presence of satellite lesions. Evaluation for regional and distant metastatic disease is necessary in all cases of advanced stage disease. Sentinel lymph node biopsy and possible parotidectomy and neck dissection should be considered in head and neck cutaneous melanomas greater than 1 mm in thickness or with ulceration. Adjuvant therapy may be indicated in advanced primary, nodal, and metastatic disease. Mucosal melanoma of the head and neck remains a difficult disease to treat, with high locoregional recurrence rates and poor prognosis despite aggressive therapy.

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“…Grade 4 toxicity resulting in complications such as skin ulceration, mucous membrane ulceration, and subcutaneous tissue necrosis was seen in 3% of patients treated to the groin. 81 In contrast, retrospective data from an MDACC series indicated that the 3-year actuarial rate of any grade 2 or 3 lymphedema following adjuvant irradiation of the inguinal nodes is 40% (27% for grade 2 alone). 84 The investigators also found that one-half of the patients who were scored as grade 2 lymphedema had evidence of lymphedema before radiation therapy.…”

Section: Toxicitymentioning

confidence: 96%

“…Another 2% of patients treated to the head and neck experienced severe induration and loss of subcutaneous tissue, or neck fibrosis. 81 However, surgery alone may cause long-term deficits. In one study of melanoma patients treated with cervical lymphadenectomy, 7% were found to have functional deficits and 6% of patients had long-term pain.…”

Section: Toxicitymentioning

confidence: 99%

“…In addition, this series reported grade 3 bone and joint complications in 2% of treated patients. 81 A recently published retrospective review evaluating field extent, axilla only versus axilla and supraclavicular fossa, indicated that equivalent axillary control of disease may be obtained, with decreased treatment complications. Although arm edema remained the most common treatment toxicity, there were no grade 3 complications seen in this series.…”

Section: Toxicitymentioning

confidence: 99%

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