Radiotherapy for Melanoma Nikhil Rao, MD

1. Radiotherapy for Melanoma
Nikhil Rao, MD

2. Introduction
 While surgical management is the mainstay of treatment for
patients with invasive cutaneous melanoma, adjuvant
radiation therapy (RT) to the primary site and/or the adjacent
nodal regions can provide significant benefit to patients who
are at high risk for local or regional recurrence

3. MelanomaRadiosensitivity

4. DesmoplasticMelanoma
 DM accounts for less than 4% of primary cutaneous
melanomas and contains melanocytes dispersed in a
prominent collagenous stroma with pleomorphic spindle-
shaped cells
 DM can have perineural involvement
 DM has been associated with increased risk of local failure

5. DesmoplasticMelanoma

6. DesmoplasticMelanoma

7. MoffittDMExperience

8. MoffittDMExperience

9. Clinicalsetupwithelectronbeam
radiotherapy

10. LocalRecurrence&Thickness
Breslow Depth
(mm)
<0.76
0.76-1.49
1.50-3.99
4
0.2% (1/707)
2.1% (15/721)
6.4% (58/907)
13.2% (38/291)
Local Recurrence
Ames et al 1992
1.5% (28/1845)
2.7% (42/1559)
6.6% (119/1805)
10.6% (63/595)
Urist et al 1985
(min FU 5 years)
H/N, ulceration, satellitosis, margins, etc also
considerations

11. AdjuvantXRTforresectednodal
disease
 Radiotherapy has shown a regional control benefit after surgery for stage III
melanoma for the following indications (based on retrospective data):
 Recurrent disease
 ECE
 >3 + nodes
 Nodal diameter >3cm
 Combinations of the above

12. RandomizedTrialsAdjuvantXRT
(Node+)

13. IMRTasAdjuvanttherapytoRight
Axilla

14. IMRTasAdjuvanttherapytoLeft
Neck

15. Radiosurgeryformelanoma:Brain

16. Radiosurgeryformelanoma:Body

17. Conclusions:
 Radiation therapy has a role in the management of high-risk melanoma as
adjuvant treatment to the primary site
 Radiation therapy plays an important role in the management of stage III
melanoma at high risk for regional failure
 Radiotherapy is effective treatment for brain metastases and other oligo-
metastatic sites in the body
 Melanoma is not radioresistant…. However targeting, dose and fractionation
matters