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Radiation treatment for locoregional recurrence and distant metastases from malignant melanoma

General

Radiation treatment provides good palliation in up to 50% of patients (1).

Indications

Radiation treatment should be considered:

  • Postoperatively, for example after resection of local relapse, and after bone and brain metastasis surgery where there is uncertainty of radicality, and where reoperation is not appropriate. For repeated locoregional relapse despite adequate surgery, or for repeated local relapse. 
  • For repeated locoregional relapse despite adequate surgery, or for repeated local relapse.
  • In some cases after lymph node dissection. Studies suggest that patients operated for metastases in the neck may benefit from postoperative irradiation, especially after perinodal growth (39). When the resection margins are not free after lymph node dissection of the axilla or groin postoperative irradiation should also be considered.
  • For painful, bleeding, or cosmetically problematic metastases, skin or subcutaneous, metastases where surgical or electrochemotherapy is not an option irradiation should be performed before the tumor volume is too large and before the tumor ulcerates. Cutaneous and subcutaneous metastases can be treated with electrons without any substantial problems for the patient. Such lesions respond often well to this kind of treatment.
  • For bone metastases causing pain or possibility of fracture. Additional surgical treatment should also be considered when fracture is feared. 
  • For metastases which compromise or threaten vital structures such as the spinal cord, nerve roots, and central airways possibly combined with surgery.
  • For brain metastases. In case of brain metastases (with other metastases under control) radiotherapy towards total brain should be considered, possibly supplied with a boost towards the tumor area. Stereotactic irradiation should be considered in case of 1-4 metastases. Transient control will be seen in 80-90 % of the patients (2).
  • Stereotactic treatment may be given in some cases towards catastases in circumscribed areas in other organs like lung, liver, spleen and the adrenals, often with good result. Stereotactic irradiation can also be given towards 1-3 metastases in the vertebral column when these are not located imidiately near the spinal canal (30). Such treatment enhances the possibility of tumor control, rapid clinical response and a more prolonged effect. Reirradiation is possible due to a reduced dosage towards the spinal cord.

Goal

  • Palliation

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