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Radiation treatment for locoregional recurrence and distant metastases from malignant melanoma

Implementation

The radiation treatment can often be carried out on an outpatient basis with weekly doctor visits. Individual factors may suggest deviation from standard treatment. These factors may be: 

  • general status 
  • risk of bleeding
  • the location of the lesion

Standard treatment

  • 3 Gy x 10, or 4 Gy x 5. 
  • 2.5 Gy up to 50 Gy, postoperative with a curative intention. 
  • 8 Gy x 1 to bone metastases.

Total brain

  • If the patient's other metastases are under control, 3 Gy x 10 to the entire brain can be administered.

Stereotactic irradiation (at Oslo University Hospital):

  • Brain metastases: 18-25 Gy x 1 depending on the diameter of the tumor.
  • Lung metastases: 15 Gy x 3 for peripherally located tumours, 7Gy x 8 for tumors at the Hilum/mediastinum.
  • Metastases in the liver, spleen, adrenals: 3 fractions 10-15 Gy depending on size and location of the tumor.
  • Vertebral column: 24 Gy x 1.

Many patients may require dexamethasone treatment during radiation treatment to the brain, or while waiting for the radiation treatment and possibly for some time after the treatment.

Irradiation combined with systemic treatment

  • BRAF inhibitors: Patients treated with BRAF inhibitors (Zelboraf®, Tafinlar®) must discontinue the treatment for around 1 week before, during and 1 week after the irradiation to avoid serious side-effects, especially from the skin.
  • Immunotherapy: Patients given Ipilimumab or PD-1 inhibitor may receive irradiation between 2 courses.
  • Chemotherapy: Patiens on DTIC or other chemotherapy may receive irradiation between 2 courses.

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