Langzeitergebnisse nach Strahlentherapie beim lokal rezidivierten und metastasierten malignen Melanom

Seegenschmiedt, M. H.; Keilholz, Ludwig; Altendorf-Hofmann, A.; Pieritz, A.; Urbán, A; Schell, H.; Hohenberger, W.; Sauer, Rolf

doi:10.1007/s001050050961

Cited by 8 publications

(7 citation statements)

References 41 publications

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“…Thus, nowadays malignant melanomas are no longer regarded as being radio‐resistant and clinical experience with radiotherapy of locoregional and distant metastases show a remission rate of up to 67%. 14–17 This is higher than achieved with most polychemoimmunotherapies. Multi‐variant analysis showed that the clinical tumour stage (UICC stage) is the most important and only independent prognostic factor for the initial and long‐term tumour control and survival after radiotherapy.…”

Section: Radiotherapymentioning

confidence: 86%

“…Radiobiological and clinical data indicate a better tumour response to hypofractionated radiotherapy (< 5 fractions per week) with higher single doses (up to 9 Gy) than with conventional fractionated radiotherapy (5 × 2 Gy/week). This is contradicted by newer randomized studies (Radiation Therapy Oncology Group 83–05) 13,17 , 18…”

Section: Radiotherapymentioning

confidence: 98%

“…Multi‐variant analysis showed that the clinical tumour stage (UICC stage) is the most important and only independent prognostic factor for the initial and long‐term tumour control and survival after radiotherapy. 17 …”

Section: Radiotherapymentioning

confidence: 99%

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Management of regional metastases

Stadler

Eich

2000

Clinical and Experimental Dermatology

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Treatment of regional melanoma metastases aims not only at local remission of the primary tumour but also at prevention or delay of distant metastases. Regional metastases can occur as satellite, in-transit and regional lymph node metastases. This is an overview of the current therapeutic modalities for regional metastatic melanoma: surgical management of relapse, satellite and in-transit metastases; therapeutic lymphadenectomy; development from elective lymph node dissection to sentinel lymph node dissection (SLND); radiotherapy and isolated limb perfusion. Instead of elective lymph node dissection the new microstaging technique by means of SLND is gaining particular importance. For this method prognostic relevance is expected and thus it is supposed to be an important staging parameter for adjuvant treatment planning.

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Section: Radiotherapymentioning

confidence: 86%

Section: Radiotherapymentioning

confidence: 98%

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Management of regional metastases

Stadler

Eich

2000

Clinical and Experimental Dermatology

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“…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 ]. While not curative, high RT doses (>30 Gy) have been shown to obtain longer disease-free survival rates and overall survival compared to patients treated with lower RT doses (≤30 Gy) [ 67 ].…”

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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“…(127) Radiotherapy is another well recognised treatment modality in the management of this disease. (233,236) This study demonstrates that a combined regimen produces high rates of robust lesion control without a clinically significant increase in toxicity. Compared to previous studies with PV-10 alone, combined therapy using PV-10 and XRT may improve clinical outcomes through a reduction in tumour volume associated with a more durable ORR secondary to improved CR and PR.…”

Section: Discussionmentioning

confidence: 74%

An evaluation of the role of locoregional treatments for the management of in-transit melanoma metastases

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In-transit melanoma metastases are a well-recognised clinical phenomenon. The disease affects a heterogeneous group of patients and encompasses a broad phenotype. While frequently characterised by a recalcitrant pattern of disease progression, patients have a variable natural history. Locoregional recurrence has traditionally been considered to portend adverse survival. However, evidence suggests that a subset of patients experience prolonged disease-specific survival and instead, face challenges secondary to quality of life. These detrimental effects may be related to treatment or the disease. Moreover, the unpredictable clinical behaviour and need for less invasive and locally administered options has led to the development of numerous therapies. Recently, locoregional treatments have gained popularity as potentially efficacious alternatives with limited toxicity and morbidity profiles relative to more aggressive strategies.Despite the multitude of therapies reported in the literature, there remains a paucity of evidence concerning treatment selection and the long-term survival outcomes of patients within large, well-defined cohorts.Consequently, there is a lack of consensus governing the management of this disease. Additional data are required to characterise this cohort of patients and describe the therapeutic benefits of the various treatments available. Patient and disease factors that can be used to select therapy must also be identified.Further, with the earlier implementation of systemic agents for metastatic disease, the effects of novel immunotherapies and the continuing role for locoregional treatments within this group need to be clearly defined. Given the complexity in clinical decision making, this thesis seeks to concisely describe the outcomes of patients, in terms of locoregional treatment effects and survival, while identifying prognostic indicators that can be used to guide subsequent care.A structured, quantitative review of the literature was undertaken to appraise existing evidence for locoregional treatments in Australia. This was followed by a retrospective review of patients treated with this condition at a single institution. A series of studies were then performed to examine the use of PV-10, radiotherapy, isolated limb infusion, and diphenylcyclopropenone for the treatment of patients with in-transit disease. Next, a phase II, prospective, randomised, pilot study was established to compare two topical immunotherapeutic agents: imiquimod and diphenylcyclopropenone for the selective treatment of epidermotropic metastases. A case report is presented highlighting the benefit of a sequential, multimodal treatment strategy for the management of in-transit melanoma. Finally, a subgroup of patients was treated using systemic anti-PD-1 immunotherapy and an analysis was performed to characterise the role of such treatments within this cohort.The treatment of this disease has rapidly evolved with a transition from radical surgical intervention to more conservative measures. This contemporary app...

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Langzeitergebnisse nach Strahlentherapie beim lokal rezidivierten und metastasierten malignen Melanom

Cited by 8 publications

References 41 publications

Management of regional metastases

Management of regional metastases

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

An evaluation of the role of locoregional treatments for the management of in-transit melanoma metastases

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