Radiation Therapy as Primary and Adjuvant Treatment for Local and Regional Melanoma

Lawrence B. Berk, MD, PhD

Disclosures

Cancer Control. 2008;15(3):233-238. 

In This Article

Radiation Therapy in the Treatment of Head and Neck Mucosal Melanomas

Salmi and Holsti[20] reported on 17 patients with head and neck mucosal melanomas. The patients received 5- Gy fractions to 40, 60, or 80 Gy. Tumors were excised 10 to 14 days after the end of radiation therapy. The degree of tumor kill correlated with dose, and extensive tumor kill occurred only after 80 Gy. There was only 1 complete response.

Wada et al[21] reported on 31 patients with mucosal head and neck melanoma. Radiation therapy was the primary treatment for 21 patients, and 10 patients received radiation therapy after surgery for gross residual disease. Complete responses were observed in 9 patients (29%) and partial responses were seen in 18 patients (58%). On multivariate analysis, dose fraction size of at least 3 Gy achieved better local control.

Klausner et al[22] reported on a trial of concurrent 5- fluorouracil (5-FU) and radiation therapy (4-Gy fractions given twice a week, 8 hours after intervenous 5-FU infusion, to 52 Gy). Among the 30 patients, 10% had a complete response and 60% had a partial response.

Owens et al[23] reported on 48 patients with mucosal head and neck melanomas. Among 20 patients treated with surgery alone, 9 (45%) had local-regional failure, while in 24 patients receiving adjuvant radiation therapy, 4 (17%) had local-regional failure. In a study by Temam et al[24] on 69 patients with mucosal head and neck melanomas, 30 patients received surgery alone and 39 received adjuvant radiation therapy. Radiation therapy was given to the large majority of patients as either 50 Gy or 70 Gy in 2-Gy fractions. Although patients receiving radiation therapy tended to have higher stage tumors, the local control rate favored radiation therapy, 62% vs 26%.

Krengli et al[25] analyzed the results of 74 patients with upper aerodigestive tract mucosal melanomas. Treatment consisted of surgery in 17 patients (23%), surgery plus radiotherapy in 42 (57%), radiotherapy in 11 (15%), and chemo-immunotherapy in 4 (5%). Definitive radiation therapy was given with a wide range of fraction sizes (median 2.0 Gy, mean 2.4 Gy) and total doses (median 60 Gy, mean 55 Gy). The 6-month disease- free survival rate was 59% for patients treated with surgery alone and 90% for patients treated with surgery plus adjuvant radiation therapy. Among 51 patients with no evidence of disease at 6 months after primary treatment, the 3-year local control rate was 57% for patients treated with surgery alone and 71% for patients treated with surgery and postoperative radiation therapy.

These retrospective data support the use of larger daily fractions for the primary control of melanomas. However, the best local control rates were obtained with the combination of surgery and adjuvant radiation therapy. The effect of fraction size in the adjuvant setting has not been elucidated.

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