Elsevier

Dermatologic Clinics

Volume 30, Issue 3, July 2012, Pages 525-533
Dermatologic Clinics

Radiation Therapy for Cutaneous Melanoma

https://doi.org/10.1016/j.det.2012.04.011Get rights and content

Introduction

In 2002, the Collaboration for Cancer Outcomes Research and Evaluation of Australia estimated that over the course of their disease approximately 23% of patients diagnosed with cutaneous melanoma (CM) would be appropriately treated with radiation therapy (RT) based on the best available evidence. Using population registry data, these investigators found that RT was part of the treatment of 13% of patients in New South Wales, Australia, and 1% to 6% of patients in the United States.1 Others have noted the infrequent and dwindling use of RT for CM over time.2, 3 Awareness of the evidence supporting the use of RT for the treatment of CM is vital to delivering the optimal care of patients with this potentially lethal disease.

Several general aspects of RT for melanoma are not addressed in this review. The myth that melanoma is not responsive to RT has been adequately described and dispelled elsewhere.3, 4, 5 The curative and organ-preserving potential of RT for uveal melanoma has been demonstrated by the Collaborative Ocular Melanoma Study6 and is beyond the scope of this review. Likewise, the role of RT in the management of mucosal melanoma is beyond the scope of this article. Herein, data providing the highest levels of evidence supporting the use of RT for CM are presented and discussed, acknowledging a significant dearth of high-level evidence in many situations.

Section snippets

Radiation therapy for the primary tumor

Although the effective use of RT as definitive local therapy for primary CM has been described,7, 8, 9, 10 the therapeutic modality of choice for resectable CM in the medically operable patient is surgery. At present, pathologic staging by surgery provides the most valuable prognostic information available for early-stage CM. However, there are situations in which surgery might preclude acceptable functional or cosmetic outcomes to some patients.

Radiation therapy for regional lymph nodes

Regional RT has been studied extensively in retrospective series and has been well summarized by Guadagnolo and Zagars.28 The topic is controversial, as evidenced by the inability to accrue patients to an intergroup trial of adjuvant RT initiated by the RTOG and ECOG (9302), or in another trial activated by ECOG alone (3697). However, 2 prospective, randomized controlled trials have been performed, and form the highest level of evidence available on this topic.

The first trial was conducted at

Radiation therapy for distant metastases

RT is most commonly used for palliative purposes in patients with metastatic melanoma.1 There is a wide variety of situations in which RT may be helpful. However, many of the research studies investigating the efficacy and toxicity of palliative RT have not focused specifically on metastatic melanoma. In many situations, extrapolating findings from other metastatic cancers is necessary. In this section, attention is paid to studies specifically studying the role of palliative RT in metastatic

Advanced techniques in radiation therapy for treatment of metastases

Advanced techniques in RT have allowed for the delivery of a single or a few high doses to several sites of metastatic melanoma. Gerszten and colleagues52 reported on the experience at the University of Pittsburgh, and found that 96% of patients reported long-term improvement in spine pain, with mean improvement of 7 points on a 10-point pain scale. Treatment with doses of 17.5 to 25 Gy was found to be safe, with no clinical or radiographic evidence of radiation-associated neurologic toxicity.

Summary

RT has a role in the management of patients with CM. As new data emerge on the relative efficacy and toxicity of RT, a change in practice patterns may be observed. Further carefully planned studies of RT in CM are necessary to optimize the outcomes of patients with this potentially lethal disease.

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    The authors have no relevant conflicts of interest.

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