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Purpose <p>Complete lymph node dissection (CLND) for stage III malignant melanoma is associated with substantial morbidity, particularly lymphatic fistulas (LF), which may delay adjuvant therapy. Grade C LF, characterized by prolonged secretion and clinical complications, lacks a standardized treatment algorithm. This study evaluated the efficacy and safety of radiotherapy in managing Grade C LF after axillary or inguinal CLND in malignant melanoma.</p> Materials and methods <p>We conducted a retrospective, single-center study of patients with stage III malignant melanoma who developed Grade C LF after axillary or inguinal CLND between 2013 and 2021 at the University Hospital Bonn. Radiotherapy was administered as either low-dose or high-dose protocols. Treatment success was defined as LF resolution within 30 days post-radiation. Toxicities were assessed using RTOG and RTOG/EORTC scores.</p> Results <p>Among 352 CLND procedures, 32 patients (9.1%) developed Grade C LF. Radiotherapy achieved resolution in 84.4% (27/32) of cases, independent site (inguinal vs. axillary, <i>p</i> = 0.999), laterality (<i>p</i> = 1.000), or timing of radiation initiation (<i>p</i> = 0.518). Low- and high-dose protocols achieved comparable success rates (89.5% vs. 76.9%, <i>p</i> = 0.347). However, high-dose radiotherapy caused significantly more acute (46.2% vs. 10.5%, <i>p</i> = 0.038) and long-term toxicities (38.5% vs. 5.3%, <i>p</i> = 0.029). Mean time to therapy success was 27 days after radiation initiation and 64 days after surgery, supporting adherence to the ESMO’s 12 week adjuvant window.</p> Conclusion <p>Grade C LF occurs in approximately 10% of patients following CLND and can delay adjuvant therapy. Radiotherapy, particularly low-dose protocols, is a safe and effective strategy to resolve LF and minimize treatment delays.</p>

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Therapy-refractory lymphatic fistulas following complete lymph node dissection in malignant melanoma: local radiotherapy as an effective therapeutic modality to avoid cancer treatment delay

  • 期刊论文

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  • 发表日期：

    2026年1月21日

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  • Johannes Röttgen,
  • Maximilian Coerper,
  • Jonas Dohmen,
  • Daniel Weissinger,
  • Steffi Marx,
  • Philipp Leyendecker,
  • Judith Sirokay,
  • Azin Jafari,
  • Jennifer Landsberg,
  • Jörg C. Kalff,
  • Philipp Lingohr,
  • Alexander Semaan

摘要

Purpose

Complete lymph node dissection (CLND) for stage III malignant melanoma is associated with substantial morbidity, particularly lymphatic fistulas (LF), which may delay adjuvant therapy. Grade C LF, characterized by prolonged secretion and clinical complications, lacks a standardized treatment algorithm. This study evaluated the efficacy and safety of radiotherapy in managing Grade C LF after axillary or inguinal CLND in malignant melanoma.

Materials and methods

We conducted a retrospective, single-center study of patients with stage III malignant melanoma who developed Grade C LF after axillary or inguinal CLND between 2013 and 2021 at the University Hospital Bonn. Radiotherapy was administered as either low-dose or high-dose protocols. Treatment success was defined as LF resolution within 30 days post-radiation. Toxicities were assessed using RTOG and RTOG/EORTC scores.

Results

Among 352 CLND procedures, 32 patients (9.1%) developed Grade C LF. Radiotherapy achieved resolution in 84.4% (27/32) of cases, independent site (inguinal vs. axillary, p = 0.999), laterality (p = 1.000), or timing of radiation initiation (p = 0.518). Low- and high-dose protocols achieved comparable success rates (89.5% vs. 76.9%, p = 0.347). However, high-dose radiotherapy caused significantly more acute (46.2% vs. 10.5%, p = 0.038) and long-term toxicities (38.5% vs. 5.3%, p = 0.029). Mean time to therapy success was 27 days after radiation initiation and 64 days after surgery, supporting adherence to the ESMO’s 12 week adjuvant window.

Conclusion

Grade C LF occurs in approximately 10% of patients following CLND and can delay adjuvant therapy. Radiotherapy, particularly low-dose protocols, is a safe and effective strategy to resolve LF and minimize treatment delays.