Surgery and adjuvant radiotherapy for cutaneous melanoma considered high-risk for local–regional recurrence

Mendenhall, William M.; Shaw, Christiana; Amdur, Robert J.; Kirwan, Jessica; Morris, Christopher G.; Werning, John W.

doi:10.1016/j.amjoto.2012.12.014

Cited by 15 publications

(8 citation statements)

References 14 publications

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“…72,[83][84][85][86][87] Hypofractionated radiotherapy appears to be equally effective as standard fractionation. These studies have shown moderate toxicity associated with adjuvant RT.…”

Section: Adjuvant Radiation For Preventing Nodal Relapsementioning

confidence: 99%

Melanoma, Version 2.2016, NCCN Clinical Practice Guidelines in Oncology

Coit¹,

Thompson²,

Algazi³

et al. 2016

J Natl Compr Canc Netw

218

167

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OverviewIn 2016, an estimated 76,380 patients will be diagnosed with and approximately 10,130 patients will die of melanoma in the United States.1 However, these figures for new cases may represent a substantial underestimate, as many superficial and in situ melanomas treated in the outpatient setting are not reported. The incidence of melanoma continues to increase dramatically, at an overall rate of 33% for men and 23% women from 2002 to 2006.2 Melanoma is increasing in men more rapidly than any other malignancy, and in women more rapidly than any other malignancy except lung cancer. AbstractThis selection from the NCCN Clinical Practice Guidelines in Oncology (NCCN Guidelines) for Melanoma focuses on adjuvant therapy and treatment of in-transit disease, because substantial changes were made to the recommendations for the 2016 update. Depending on the stage of the disease, options for adjuvant therapy now include biochemotherapy and highdose ipilimumab. Treatment options for in-transit disease now include intralesional injection with talimogene laherparepvec (T-VEC), a new immunotherapy. These additions prompted reassessment of the data supporting older recommended treatment options for adjuvant therapy and in-transit disease, resulting in extensive revisions to the supporting discussion sections. J Natl Compr Canc Netw 2016;14(4):450-473 NCCN Categories of Evidence and ConsensusCategory 1: Based upon high-level evidence, there is uniform NCCN consensus that the intervention is appropriate. Category 2A: Based upon lower-level evidence, there is uniform NCCN consensus that the intervention is appropriate. Category 2B: Based upon lower-level evidence, there is NCCN consensus that the intervention is appropriate. Category 3: Based upon any level of evidence, there is major NCCN disagreement that the intervention is appropriate.All recommendations are category 2A unless otherwise noted.Clinical trials: NCCN believes that the best management for any cancer patient is in a clinical trial. Participation in clinical trials is especially encouraged. Please NoteThe NCCN Clinical Practice Guidelines in Oncology (NCCN Guidelines ® ) are a statement of consensus of the authors regarding their views of currently accepted approaches to treatment. Any clinician seeking to apply or consult the NCCN Guidelines ® is expected to use independent medical judgment in the context of individual clinical circumstances to determine any patient's care or treatment. The National Comprehensive Cancer Network ® (NCCN ® ) makes no representation or warranties of any kind regarding their content, use, or application and disclaims any responsibility for their applications or use in any way. The full NCCN Guidelines for Melanoma are not printed in this issue of JNCCN but can be accessed online at NCCN.org.© National Comprehensive Cancer Network, Inc. 2016, All rights reserved. The NCCN Guidelines and the illustrations herein may not be reproduced in any form without the express written permission of NCCN. Disclosures for the NCCN Melanoma ...

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“…72,[83][84][85][86][87] Hypofractionated radiotherapy appears to be equally effective as standard fractionation. These studies have shown moderate toxicity associated with adjuvant RT.…”

Section: Adjuvant Radiation For Preventing Nodal Relapsementioning

confidence: 99%

Melanoma, Version 2.2016, NCCN Clinical Practice Guidelines in Oncology

Coit¹,

Thompson²,

Algazi³

et al. 2016

J Natl Compr Canc Netw

218

167

View full text Add to dashboard Cite

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“…Radiation therapy (RT) is not typically indicated for IT disease. Conversely, it is more often utilized in patients with high-risk local-regional recurrence, including patients with desmoplastic melanoma or high nodal disease burden [ 60 , 61 , 62 , 63 ]. However, RT has a beneficial role in the palliation of local symptoms, such as bleeding, pain and fungating infections, which may result from extensive IT disease [ 64 , 65 , 66 ].…”

Section: Radiationmentioning

confidence: 99%

The Role of Regional Therapies for in-Transit Melanoma in the Era of Improved Systemic Options

Gabriel¹,

Skitzki²

2015

Cancers

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The incidence of melanoma has been increasing at a rapid rate, with 4%–11% of all melanoma recurrences presenting as in-transit disease. Treatments for in-transit melanoma of the extremity are varied and include surgical excision, lesional injection, regional techniques and systemic therapies. Excision to clear margins is preferred; however, in cases of widespread disease, this may not be practical. Historically, intralesional therapies were generally not curative and were often used for palliation or as adjuncts to other therapies, but recent advances in oncolytic viruses may change this paradigm. Radiation as a regional therapy can be quite locally toxic and is typically relegated to disease control and symptom relief in patients with limited treatment options. Regional therapies such as isolated limb perfusion and isolated limb infusion are older therapies, but offer the ability to treat bulky disease for curative intent with a high response rate. These techniques have their associated toxicities and can be technically challenging. Historically, systemic therapy with chemotherapies and biochemotherapies were relatively ineffective and highly toxic. With the advent of novel immunotherapeutic and targeted small molecule agents for the treatment of metastatic melanoma, the armamentarium against in-transit disease has expanded. Given the multitude of options, many different combinations and sequences of therapies can be offered to patients with in-transit extremity melanoma in the contemporary era. Reported response and survival rates of the varied treatments may offer valuable information regarding treatment decisions for patients with in-transit melanoma and provide rationale for these decisions.

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“…Retrospective studies suggest equivalence of hypofractionated and conventional treatment fractionation. 95,98 However, side effects of adjuvant radiation therapy can include the risk of lymphedema, particularly with axillary and inguinal radiation where up to 50% of patients can experience lymphedema. In a recent study of 20 patients receiving adjuvant radiation to the axilla and inguinal regions, 15 of whom received intensity modulated radiation therapy, the rate of Grade 1-2 lymphedema was 45% with one incident of Grade 3 lymphedema.…”

Section: Adjuvant Radiationmentioning

confidence: 99%

Treating melanoma in adolescents and young adults: challenges and solutions

Kumar¹,

Messina²,

Sondak³

et al. 2015

COAYA

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Systemic therapy of melanoma has made tremendous progress recently for advanced stage patients in terms of excellent, temporary responses through targeting underlying biology of BRAF V600E mutation and affected pathways. A significant subset of patients with advanced disease also has durable responses from immunomodulation through immune checkpoint blockade of CTLA-4 and the PDL-1/PD-1 axis. Clinical trials of these agents included patients as young as 18 years but generally excluded younger adolescents. Ongoing trials in 12-17 year olds have not been accruing as robustly, and as a result available options for these patients are often lagging years behind their adult counterparts. We herein summarize the epidemiology, diagnosis, and multidisciplinary management of adolescents and young adults with melanoma. We offer recommendations to improve the care for adolescent patients with melanoma agespecific evaluations and by including them in up-front melanoma trials.

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Surgery and adjuvant radiotherapy for cutaneous melanoma considered high-risk for local–regional recurrence

Cited by 15 publications

References 14 publications

Melanoma, Version 2.2016, NCCN Clinical Practice Guidelines in Oncology

Melanoma, Version 2.2016, NCCN Clinical Practice Guidelines in Oncology

The Role of Regional Therapies for in-Transit Melanoma in the Era of Improved Systemic Options

Treating melanoma in adolescents and young adults: challenges and solutions

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