What is the role of radiotherapy in the treatment of head and neck mucosal melanomas?

Updated: May 07, 2020
  • Author: Neeraj N Mathur, MBBS, MS, DNB(ENT), MNAMS, FAMS; Chief Editor: Arlen D Meyers, MD, MBA  more...
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Answer

The role of radiotherapy in the treatment of mucosal melanoma is not clearly defined, and malignant melanoma has traditionally been regarded as relatively insensitive to radiation, but some studies have suggested a positive benefit. [11, 12] In vitro studies on cutaneous melanoma cell lines show that they may not be intrinsically radioresistant, and high dose-per-fraction treatment is necessary. Ample clinical and basic scientific evidence lends support to the theory that melanoma has a high capacity for sublethal damage repair, making it resistant to conventional fractionation schemes.

Therefore, treatment is often more successful with higher doses. Shibuya et al reported equal or better local control rates when using radiation as primary treatment modality. [13] In spite of its beneficial effect, radiotherapy is usually applied as an adjuvant modality reserved for positive surgical margins, local recurrence, or palliation. [14] Statistical analysis has not confirmed that surgery with additional radiotherapy improves the patient’s overall survival significantly, and, therefore, the role of postoperative radiotherapy is not settled.

In a review of 69 patients with mucosal melanoma, Temam et al found local control rates were 26% with surgery alone and 62% with postoperative radiation therapy, even though the individuals in the radiotherapy group had much more locally advanced tumors. [15] Patients who received surgery alone had a median local disease-free survival period of 9 months, and patients in the postoperative radiotherapy group had a median survival period of 33 months. Patients in the postoperative radiotherapy group, however, developed distant metastasis more rapidly than patients in the surgery group did. [15]

Owens et al did a comparable study at the University of Texas MD Anderson Cancer Center and showed that the addition of radiotherapy decreased the rate of local disease recurrence but did not significantly improve survival. [16]

Another study conducted by Temam et al in France found that the postoperative radiotherapy improves local control. [17] This was particularly significant for small tumors for which the occurrence of metastases was related to local control and its corollary, survival.

Cutaneous malignant melanoma has been treated with neutron beam radiotherapy with good results in controlling disease locally in patients with stage III melanoma. Whether these results can be extrapolated to the mucosal counterpart of the disease remains to be seen. [18]

Morris et al found that radiation-induced oral mucositis was a complication of boron neutron capture therapy, particularly with the use of p -boronophenylalanine. [19]


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