Radiation therapy in the management of melanoma
- Anand Mahadevan, MD
Anand Mahadevan, MD
- Assistant Professor of Radiation Oncology
- Harvard Medical School
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 . 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].To continue reading this article, you must log in with your personal, hospital, or group practice subscription. For more information on subscription options, click below on the option that best describes you:
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- DOSE AND SCHEDULE
- CUTANEOUS LESIONS
- Primary lesion
- - Lentigo maligna
- - Deeply invasive melanoma
- Desmoplastic melanoma
- MUCOSAL MELANOMA
- UVEAL MELANOMA
- REGIONAL LYMPH NODES
- Adjuvant RT after lymph node dissection
- Adjuvant RT without lymph node dissection for head and neck melanoma
- Complications of regional RT
- PALLIATIVE RT
- Visceral, cerebral, and skeletal metastases
- STEREOTACTIC RADIOSURGERY AND STEREOTACTIC BODY RADIATION
- Brain metastasis
- Extracranial oligometastasis
- COMBINED RT AND SYSTEMIC TREATMENTS
- Radiation therapy plus BRAF inhibition
- Radiation therapy and immune checkpoint inhibitors
- INFORMATION FOR PATIENTS