Carbon‐ion radiotherapy combined with chemotherapy for head and neck mucosal melanoma: Prospective observational study

Abstract

This study aimed to evaluate the efficacy of carbon‐ion radiotherapy in combination with chemotherapy using dacarbazine, nimustine, and vincristine (DAV therapy) in mucosal melanoma. Twenty‐one patients with clinically localized mucosal melanoma of the head and neck were enrolled. The primary endpoint was 3‐year overall survival (OS). Secondary endpoints included local control, progression‐free survival (PFS), and adverse event occurrence. Carbon‐ion radiotherapy with a dose of 57.6‐64.0 Gy (relative biological effectiveness) in 16 fractions was delivered concurrently with DAV therapy, and 2 cycles of adjuvant DAV therapy were administered every 6 weeks. The median follow‐up periods were 15.5 months for all patients, and 31.2 months for 12 surviving patients. All patients had locally advanced T4a or T4b disease in the rhino‐sinus area. In 16 patients (76.2%), 3 cycles of planned DAV therapy were completed. The 3‐year OS and PFS rates were 49.2% and 37.0% respectively. The 3‐year local control rate was 92.3%. Eleven patients (52%) developed distant metastasis, which was the most frequent pattern of the first failure. Commonly presenting acute grade 2‐3 toxicities associated with radiotherapy and chemotherapy were mucositis (11 patients [53%]) and leukopenia (9 patients [43%]), which improved with conservative therapy. None of the patients developed grade 3 or greater late toxicities. Carbon‐ion radiotherapy in combination with DAV therapy led to excellent local control for advanced mucosal melanoma within acceptable toxicities. The efficacy of additional DAV therapy in improving survival was weaker than expected as distant metastases still occurred frequently. Trial registration no. UMIN000007939.

Efficacy and safety of carbon‐ion radiotherapy for the malignant melanoma: A systematic review

“…Koto et al suggested that concurrent chemotherapy was a markedly independent factor for OS, 26 similar to results of concurrent chemo‐RT in patients with inoperable locally advanced nonsmall cell lung cancer 28 . A recent study by Takayasu et al may have included the same patients as Shirai et al, therefore the former publication was not included in this review 29 . They suggested that efficacy of DAV therapy combined with CIRT increased survival rates, 29 however, also opposite results were reported 30 .…”

“…A recent study by Takayasu et al may have included the same patients as Shirai et al, therefore the former publication was not included in this review 29 . They suggested that efficacy of DAV therapy combined with CIRT increased survival rates, 29 however, also opposite results were reported 30 . The patients included in the Shirai et al study were as well included in that of Koto et al; thus, further studies with larger sample sizes are required to determine whether concurrent chemotherapy is a predictor of OS rates.…”

Carbon Ion Dose Constraints in the Head and Neck and Skull Base: Review of MedAustron Institutional Protocols

“…The CIRT has been used to treat several tumors of the head and neck area. It has not been employed for squamocellular carcinoma-the most common entity-but rather, for other, radioresistant histologies, such as salivary gland tumors [15][16][17][18][19][20][21][22], paranasal sinuses tumors (including sinonasal undifferentiated carcinoma, sinonasal adenocarcinoma, intestinal-type adenocarcinoma, and esthesioneuroblastoma, among others) [15,23], mucosal melanoma [24][25][26][27][28], lacrimal gland tumors [29][30][31], and bone and soft tissue sarcoma (including tumors of the skull base and cervical spine [32][33][34][35][36][37][38] At MedAustron, CIRT was begun in July 2019. Until September 2020, 91 patients have been treated and 42 of them had tumors in the head and neck.…”

The Role of Particle Therapy in Adenoid Cystic Carcinoma and Mucosal Melanoma of the Head and Neck

“…Takayasu and colleagues [ 81 ] at Gunma University conducted a prospective observational study of combination CIRT with dacarbazine, nimustine, and vancristine for MM. Twenty-one patients with T4a or T4b rhinosinus disease were treated with CIRT to 57.6 to 64.0 GyRBE in 16 fractions, with 2 to 3 cycles of adjuvant dacarbazine, nimustine, and vancristine.…”

“…Distant failure occurred in 52% of patients. No patients developed grade 3 or higher toxicity [ 81 ].…”