Radiotherapy for Melanoma Nikhil Rao, MD
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This document discusses the use of radiotherapy for different types of melanoma. It notes that while surgery is the main treatment for invasive cutaneous melanoma, adjuvant radiation therapy can provide benefits for patients at high risk of local or regional recurrence. Specifically, it focuses on desmoplastic melanoma, which has a risk of local failure and perineural involvement. Data is presented on using electron beam radiotherapy for desmoplastic melanoma. The document also reviews using radiotherapy as adjuvant treatment for resected nodal disease in stage III melanoma and randomized trials examining adjuvant radiotherapy for node-positive melanoma patients. It concludes that radiation therapy plays a role in managing high-risk primary melanoma and stage III melanoma, and can be effective for treating
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3. Specific sarcoma subtypes are discussed, along with their characteristics, risk factors, locations, recurrence rates, and treatments. These include desmoid tumors, dermatofibrosarcoma protuberans, liposarcoma subtypes, leiomyosarcoma, and others.
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This document discusses lip cancer including its incidence, risk factors, workup, management, reconstruction techniques, and prognosis. Some key points:
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4part2
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- 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
- 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
- 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
- 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