Critical appraisal:Barbour S, Mark Smithers B, Allan C, Bayley G, Thomas J, Foote M, et al 2015

Critical Appraisal

Article being appraised

Barbour S, Mark Smithers B, Allan C, Bayley G, Thomas J, Foote M, et al. Patterns of Recurrence in Patients with Stage IIIB/C Cutaneous Melanoma of the Head and Neck Following Surgery With and Without Adjuvant Radiation Therapy: Is Isolated Regional Recurrence Salvageable? Ann Surg Oncol 2015 Jan 13 Available from: http://www.ncbi.nlm.nih.gov/pubmed/25582744.

Applicable clinical question

What is the appropriate treatment for macroscopic (i.e. detectable clinically or by ultrasound) nodal metastasis?

Key Facts

Study Design

cohort study

Study aims:

The study was undertaken to identify prognostic factors and recurrence patterns for patients with stage IIIB/C head and neck melanoma (HNM) treated with TLND ± RT. In addition, we determined the use and outcomes of salvage therapy for regional recurrence after TLND ± RT.

Number of Patients:

173

Reported outcome(s):

Prognostic factors of recurrence-free survival (RFS) and Disease-free survival (DFS)
Distant disease prgoression

Results of outcome(s):

The 5-year (DFS), melanoma-specific survival (MSS) and OS for all patients was 46, 55 and 53%. The surgery-alone group had a significantly better DFS (median 123 months, 54% 5-year DFS) compared with adjuvant RT patients (median 17 months, 32% 5-year DFS; p=0.022, log rank).
The majority of recurrences (91%) occurred within 5 years after surgery. Overall RFS was 46%, 78 patients developed recurrence. Comparing the surgery-alone and adjuvant RT groups, there is 5-year overall recurrence rate of 46% (43 patients) for surgery alone and 68% (35 patients) for the adjuvant RT group (p=0.011; log rank).
The 5-year distant recurrence rate was 38% with 33 events for the surgery-alone group compared with 60% with 28 events for the adjuvant RT group (p=0.019); log rank).

Includes an economic evaluation

no