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Radiation therapy in the management of melanoma

Author
Anand Mahadevan, MD
Section Editor
Michael B Atkins, MD
Deputy Editor
Michael E Ross, MD

INTRODUCTION

Although historically melanoma was considered a relatively radioresistant tumor, radiation therapy (RT) can be a useful treatment option for patients with melanoma in some settings. RT can provide effective palliation for the 40 to 50 percent of patients who develop unresectable, locally recurrent, or symptomatic metastatic disease, like those with bone pain, epidural spinal cord compression, or central nervous system symptoms. Stereotactic radiosurgery (SRS) and stereotactic body RT (SBRT) can be particularly effective in ablating limited (oligometastatic) metastasis.

RT has also been utilized after complete excision of a primary melanoma or after therapeutic lymphadenectomy for regional nodal disease as adjuvant therapy and to reduce the rate of local recurrence for certain types of melanoma, although its role in this setting is less clear. Rarely, it has been used as a primary treatment after inadequate excision or as definitive treatment for carefully selected melanomas.

Based upon important developments in targeted therapy and immunotherapy, systemic therapy is the preferred option in most clinical settings, with RT use reserved for palliation or for consolidation in patients not achieving a complete response to systemic treatment. Multidisciplinary consultation is required to assure optimal patient care.

The potential roles of RT in the management of patients with melanoma are reviewed here. The role of systemic therapy in the management of advanced melanoma is presented separately. (See "Overview of the management of advanced cutaneous melanoma".)

DOSE AND SCHEDULE

The notion that melanoma is intrinsically radioresistant initially arose from cell culture studies [1-4], which showed a broad shoulder in the cell survival curves, implying better response to higher dose per fraction and an unusually high repair capacity [5]. Some early clinical observations using large fractions of radiation per fraction supported these laboratory findings. However, other studies did not observe a difference between various large fraction schedules, and some single institution series reported similar outcomes with conventional fractionation schedules [6-8].

                     

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Literature review current through: Nov 2016. | This topic last updated: Thu Oct 06 00:00:00 GMT 2016.
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