Patterns of failure and predictors of outcome in cutaneous malignant melanoma of the scalp.

BACKGROUND: Patients with melanoma of the scalp may have higher failure (recurrence) rates than melanoma of other body sites. OBJECTIVE: We sought to characterize survival and patterns of failure for patients with scalp melanoma. METHODS: Between 1998 and 2010, 250 nonmetastatic patients underwent wide local excision of a primary scalp melanoma. Kaplan-Meier analyses were performed to evaluate overall survival, scalp control, regional neck control, distant metastases-free survival, and disease-free survival. RESULTS: Five-year overall survival was 86%, 57%, and 45% for stages I, II, and III, respectively, and 5-year scalp control rates were 92%, 75%, and 63%, respectively. Five-year distant metastases-free survival for these stages were 92%, 65%, and 45%, respectively. Of the 74 patients who recurred, the site of first recurrence included distant disease in 47%, although 31% recurred in the scalp alone. LIMITATIONS: This is a retrospective review. CONCLUSION: Distant metastases-free survival and overall survival for stage II and III patients with scalp melanoma are poor, and stage III patients experience relatively high rates of scalp failure suggesting that these patients may benefit from additional adjuvant systemic and local therapy. Further research is needed to characterize the environmental, microenvironmental, and genetic causes of the increased aggressiveness of scalp melanoma and to identify more effective treatment and surveillance methods.

The Prognostic Significance of Facial Nerve Involvement in Carcinomas of the Parotid Gland.

IMPORTANCE AND BACKGROUND: Facial nerve (FN) palsy and perineural invasion (PNI) are adverse features in carcinomas of the parotid gland. FN sacrifice at the time of surgery is associated with significant morbidity. The role of adjuvant radiotherapy in patients with high-risk features, including FN involvement, remains unclear. OBJECTIVE: Analyze the disease-free survival (DFS) and overall survival (OS) and the impact of tumor characteristics, including FN involvement, for patients treated with surgical resection for carcinoma of the parotid gland. DESIGN: This is a retrospective chart review. SETTING: University of Utah and Intermountain Healthcare, Utah. PARTICIPANTS: A total of 129 patients who were treated with primary surgery for nonmetastatic primary malignancies of the parotid gland from 1988 to 2006. INTERVENTIONS: Parotidectomy with or without adjuvant therapy. MAIN OUTCOME(S) AND MEASURES: Kaplan-Meier analysis was used to obtain 5-year estimates of DFS and OS. Recurrence risk factors, particularly the impact of FN involvement, were analyzed. RESULTS: Five-year DFS and OS rates were 79% and 78%, respectively. Thirty-two (28%) patients developed recurrent disease. Disease recurrence occurred in 64% of patients with both FN palsy and PNI, in 43% with FN palsy without PNI, in 27% with only PNI, and in 16% without either feature. CONCLUSIONS AND RELEVANCE: FN involvement, particularly FN palsy, is a predictor of increased risk of recurrence and death. Radiotherapy cannot substitute for FN sacrifice in high-risk patients.

Tumor control and incidence of radiation necrosis after reirradiation with stereotactic radiosurgery for brain metastases.

OBJECTIVES: To determine the ability of a second course of stereotactic radiosurgery (SRS) to control brain metastases as well as to document the incidence of radiation necrosis (RN) after reirradiation with SRS. METHODS AND MATERIALS: Between 2001 and 2010, 37 patients with 43 retreated lesions were treated with ≥2courses of SRS to the same brain metastasis. Patient, tumor, and treatment characteristics as well as follow-up data were collected. Magnetic resonance imaging was reviewed to assess tumor response to treatment. Development of RN, as confirmed by pathology or imaging, was recorded. Local control, overall survival, and predictors of RN were analyzed. RESULTS: The most common histology was melanoma (n=20, 47%) followed by lung (n=9, 21%), and breast (n=8, 19%) cancer. RN was identified in 7/43 (16%) lesions. Using a competing risk model for analysis, with death as the competing risk, the incidence of RN was 11.6% and 16.5% at 6 and 12 months, respectively, and the incidence of local failure was 16.7% and 19.4% at 6 and 12 months, respectively. There was not a statistically significant association between radiation dose, mean tumor size, number of months between SRS courses, use of WBRT, or use of surgery and the development of RN. Median survival after the second course of SRS was 8.3 months, and median survival for those with and without RN was 14.1 and 7.7 months, respectively (p=0.23). CONCLUSION: Reirradiation with SRS can lead to tumor response in the majority of patients with a low incidence of RN.

A surveillance, epidemiology, and end results registry analysis of prostate cancer modality time trends by age.

OBJECTIVE: To use the Surveillance, Epidemiology, and End Results (SEER) registry to analyze age-specific time trends in the use of radiotherapy (RT) (external beam radiotherapy [EBRT], brachytherapy [brachy], and combination therapy [combo]) as first-line treatment for prostate cancer. METHODS: A total of 820,649 prostate cancer patients in the SEER public-use registry (1973-2004) with diagnosis year, treatment, and age information available were identified. Modality use time-trend curves were plotted for patients 45 to 85+ years of age, grouped in 5-year intervals. A nonparametric (Spearman) test was used to assess the correlation between diagnosis year and (a) percentage use of RT and (b) relative percentage use of EBRT, brachy, and combo therapy. RESULTS: Over the study period from 1973 to 2004, RT use increased in patients ≥65 years of age, but has remained stable in patients <65 years of age. All age groups experienced a similar relative rise in the use of brachy and combo therapy, with brachy use surpassing combo use in approximately year 2000. CONCLUSIONS: Trends in treatment choice for early prostate cancer generally reflect treatment advances, but do not appear to be uniform among all age groups. The SEER database is a valuable asset for analyzing these trends and can be used to investigate age-specific treatment patterns.