Radiation Therapy for Melanoma

Abstract

Although melanoma is a relative radioresistant tumor, radiation therapy (RT) remains a valid and effective treatment option for the management of melanoma. RT as a primary treatment is often offered in well-defined situations, such as medical inoperability, lentiginous melanoma, mucosal melanoma, and ocular melanoma. Adjuvant RT following lymphadenectomy in node-positive melanoma patients prevents local and regional recurrence; however, the role of adjuvant RT remains controversial and underutilized due to lack of overall survival benefit. On the other hand, RT is highly effective in providing symptom palliation for metastatic melanoma and is widely used. Advanced RT technologies such as stereotactic radiosurgery (SRS) and stereotactic body radiotherapy (SBRT) can achieve excellent local control with minimum toxicities. They are commonly used in the management of brain, lung, spine, and liver metastases. Most recently, it is under active investigation on combining RT with new systemic options, such as targeted therapy, or immunotherapy. The advancements in the treatment of patients with melanoma highlight the importance of multidisciplinary management in this disease. Radiation therapy will continue to be one of the key therapeutic options.

Emergent Nanotechnological Strategies for Systemic Chemotherapy against Melanoma

“…Cancer cells subjected to radiotherapy suffer DNA damage. At low dose, melanoma cells are able to effectively repair these damages due to high proliferation capacity, efficient enzymatic system and poor cell differentiation [28,29]. Therefore, this treatment modality has a limited application for melanoma patients, being selected for specific clinical cases.…”

“…Radiotherapy is still an option in melanoma management, with advances being accomplished in terms of real-time imaging and improved dose regimen according to disease progress. In addition, the combination of radiotherapy with existing systemic therapeutic approaches is under study [29].…”

Complete and Durable Response After Radiation Therapy to Primary Tumor Site of a Patient With Metastatic Anorectal Mucosal Melanoma With Oligoprogression on Nivolumab

“…2 Radiation therapy (RT) in mucosal melanoma has shown promise in certain settings but indications remain poorly defined. 3,4 Immune checkpoint inhibitors have shown excellent response rates in metastatic melanoma and are increasingly used for mucosal melanoma; however, most patients will eventually progress. Response patterns are highly variable among patients who respond to immunotherapy.…”

Complete Response After Stereotactic Body Radiation Therapy With Concurrent Immunotherapy for Vaginal Melanoma

“…Exact mechanisms of interaction between IO and RT are incompletely characterized, though responses are attributed to potential synergistic immune modulation [27,28]. Melanoma is relatively radioresistant with high intrinsic repair capacity at lower RT doses [29][30][31]. With a low α/β ratio, hypofractionation with dose-escalation offers a theoretical advantage and improved local control of metastatic melanoma compared to conventional fractionation [32].…”