The Evolving Role of Radiation Therapy in the Management of Malignant Melanoma

Abstract

The incidence of melanoma is rising in the United States, leading to an estimated 68,720 new diagnoses and 8,650 deaths. The natural history involves metastases to lymph nodes, lung, liver, brain, and often to other sites. Primary treatment for melanoma is surgical excision of the primary tumor and affected lymph nodes. The role of adjuvant or definitive radiation therapy in the treatment of melanoma remains controversial, as melanoma has traditionally been viewed as a prototypical radioresistant cancer. However, recent studies suggest that under certain clinical circumstances, there may be a significant role for radiation therapy in melanoma treatment. Stereotactic radiosurgery for brain metastases has shown effective local control. High dose per fraction radiation therapy has been associated with a lower rate of locoregional recurrence of sinonasal melanoma. Plaque brachytherapy has evolved into a promising alternative to enucleation at the expense of moderate reduction in visual acuity. Adjuvant radiation therapy following lymphadenectomy in node positive melanoma prevents local and regional recurrence. The newer clinical data along with emerging radiobiological data indicate that radiotherapy is likely to play a greater role in melanoma management, and should be considered as a treatment option.

Synergistic cytotoxicity of radiation and oncolytic Lister strain vaccinia in V600D/EBRAF mutant melanoma depends on JNK and TNF-α signaling

“…It is classically regarded as relatively resistant to radiation therapy (13). As a result, for many years, most oncologists have viewed MMM nihilistically as an essentially untreatable disease.…”

“…This tumor type frequently presents with multiple cutaneous and subcutaneous deposits and represents an attractive model for early phase clinical studies of combinations of oncolytic viruses and radiation -not least because of its poor prognosis and relative radioresistance, but its accessibility for direct intratumoral injection and the potential to obtain repeated biopsies to measure pharmacodynamic markers (13). In addition, recent impressive results with the BRAF inhibitor, vemurafenib, suggest that malignant melanoma is an excellent scenario in which to test molecularly targeted agents (14).…”

Diagnostic and Therapeutic Approaches in Italian Hospitals: Adjuvant and Metastatic Therapy in Melanoma

“…However, this response is contradicted by the response to the specific question on the use of radiotherapy, to which high-volume centers responded that they use it in 22% of patients at high risk of lymph node recurrence and low-volume centers in 32%. These percentages are higher than expected based on the lack of randomized trials clearly supporting a survival benefit from adjuvant radiotherapy after lymphadenectomy at high risk of relapse [18,19]. However, various guidelines, including those of the Italian Association of Medical Oncology, recommend adjuvant radiotherapy in patients with extra-nodal involvement, more than 4 lymph nodes involved, or diameter >4-6 cm, especially if located in the head or neck.…”

Management options for metastatic melanoma in the era of novel therapies: A primer for the practicing dermatologist

“…SRS, which includes linear accelerator and gamma knifeebased techniques, can minimize side effects, such as edema or radiation necrosis, 64 produce 1-year local control rates ranging from 49% to 97%, and result in an improvement in quality of life. [65][66][67][68][69][70][71] When combined with WBRT, SRS has at least equivalent survival compared to surgery and WBRT. [72][73][74] The addition of either surgical resection or SRS to WBRT improves outcomes when compared with WBRT alone for patients with a single or small number of intracranial metastases.…”