Postoperative radiotherapy for primary mucosal melanoma of the head and neck

Abstract

BACKGROUND Primary head and neck mucosal melanoma (HNMM) has a poor prognosis with a low local control rate and frequent distant metastases. The objective of the current study was to determine the impact of postoperative radiotherapy on local control and survival. METHODS One hundred forty‐two patients with primary HNMM treated between 1979 and 1997 were reviewed. Of these, 69 patients with confirmed primary mucosal melanoma, absence of metastatic disease, and definitive management by surgery with or without postoperative radiotherapy and follow‐up at the Institut Gustave‐Roussy (Villejuif) were selected. The site of primary HNMM was sinonasal in 46 patients, oral in 19 patients, and pharyngolaryngeal in 4 patients. Twenty‐two patients (32%) had a locally advanced tumor (T3–T4) and 17 patients had regional lymph node metastases after pathologic examination (pN > 0). Thirty patients underwent surgery alone and 39 received postoperative radiotherapy. Patients with locally advanced tumors had received postoperative radiotherapy more frequently than those with small tumors (P = 0.02). RESULTS Thirty‐seven patients (54%) experienced local disease recurrence and 47 patients (68%) developed distant metastasis. The overall survival rates were 47% at 2 years and 20% at 5 years. In the Cox multivariate analysis, patients with early T‐classification tumors who received postoperative radiotherapy had a better local disease‐free survival (P = 0.004 and P = 0.05, respectively) compared with patients with late T‐classification tumors who did not receive postoperative radiotherapy. Patients with advanced T‐classification and pN > 0 stage had a shorter distant metastasis disease‐free survival compared with patients with early T‐classification and pN < 0 stage. Patients with advanced T‐classification tumors had a shorter overall survival compared with patients with early T‐classification tumors (P = 0.003). CONCLUSIONS The prognosis of patients with HNMM was poor. Patients had a high rate of distant metastasis and a low rate of local control. The current study suggested that postoperative radiotherapy increased local control even for patients with small tumors. Cancer 2005. © 2004 American Cancer Society.

Mélanomes de la cavité buccale : présentation de 3 cas

“…Après son repérage, le ganglion est prélevé et examiné histologiquement : le curage est envisagé seulement si une métastase ou une micrométastase est décelée [19]. La radiothérapie peut être primaire pour les grosses tumeurs inopérables ou chez les patients âgés, ou complémentaire car elle permettrait un meilleur contrôle local sans modification significative de la survie [20,21]. Le 3 e cas a bénéficié d'une radiothérapie complémentaire qui semble avoir été insuffisante pour éviter les métastases après une chirurgie conservatrice.…”

Sinonasal mucosal melanomas in Quito, Ecuador

“…[15][16][17][18][19] However, some authors have reported improved survival is selected groups with postoperative RT. [20][21][22] Patients with unresectable local disease or that cannot be operated for medical reasons or those who do not agree for surgery should be considered for radiotherapy alone as a definitive management, whereas chemotherapy should be reserved for patients with systemic disease. Long-term survival for patients treated with RT alone remains uncertain.…”

“…Number of cases University of Campinas, Piracicaba, São Paulo, Brazil (14) 12 Institut Gustave Roussy, Villejuif, France (20) 1979-1997 46 Finish Nationwide Study, Finland (27) 1990 Several new biologic and immunomodulatory treatments are currently being investigated for use in patients with mucosal melanoma. KIT and BRAF mutations, which are accessible for present targeted therapies, are only rarely present in SNMMs, whereas NRAS mutations seem to be relatively more frequent.…”

Primary sinonasal mucosal melanoma – Case report and literature review

“…Surgery represents the first option for treatment, but it has its limitations regarding the complete tumor excision or the accessibility to the tumor site. Postoperative radiotherapy is a frequent recommendation for these patients 6 . In order to improve survival in advanced mucosal melanoma, the course of action includes adjuvant chemotherapy and palliation 6 .…”

“…Postoperative radiotherapy is a frequent recommendation for these patients 6 . In order to improve survival in advanced mucosal melanoma, the course of action includes adjuvant chemotherapy and palliation 6 . New immunologic and targeted therapies are always developing, but in the case of mucosal melanoma, especially the head and neck region, BRAF mutation, which is common in cutaneous melanoma, is very rare for this site 7 .…”