Critical appraisal:Barbour S, Mark Smithers B, Allan C, Bayley G, Thomas J, Foote M, et al 2015 3

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

Is adjuvant radiotherapy of value following resection of involved lymph nodes?

Key Facts

Study Design

cohort study

Study aims:

To identify prognostic factors and recurrence patterns for patients with stage IIIB/C head and neck melanoma (HNM) treated with therapeutic lymph node dissection (TLND) ± Radiotherapy (RT).

Number of Patients:

173

Reported outcome(s):

5 year Disease-free survival (DFS)
Overall Survival

Results of outcome(s):

The surgery-alone group had significantly better DFS (median 123 months, 54 % 5-year DFS) compared with the adjuvant RT patients (median 17 months, 32 % 5-year DFS; p = 0.011, log rank).

There were no significant differences in MSS (surgery alone 56 % vs. RT 53 %; p = 0.406, log rank) or OS (surgery alone 53 % vs. adjuvant RT 51 %; p = 0.571, log rank).

Comparing the surgery-alone and adjuvant RT groups reveals a 5-year overall recurrence rate of 46 % (43 patients) following surgery alone compared with 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