Future of radiation therapy for malignant melanoma in an era of newer, more effective biological agents

Figures & data

Table 1 Guidelines for surgical excision of melanoma, from the National Cancer Center Network Practice Guidelines in Oncology¹⁵

Tumor thickness	Recommended margins
In situ	0.5 cm
<1.0 mm	1.0 cm
1.01–2 mm	1–2 cm
2.01–4 mm	2.0 cm
>4 mm	2.0 cm

Table 2 Role of linear accelerator stereotactic radiosurgery in the treatment of melanoma brain metastases

Study	Patients (n)	One-year LC	One-year OS	Comments
Mori et al^Citation34	60 51 (WBRT + SRS)	90%	7 months	Improved survival on multivariate analysis included lack of active systemic disease and at least one metastasis.
Selek et al^Citation35	103	49%	6.7 months	75% LC for tumors < 2 cm with initial SRS alone
	61 (SRS)	60%	7.5 months
	12 (SRS + WBRT)	0%	3.7 months
	30 (SRS after WBRT)	37%	5.4 months

Abbreviations: LC, local control; OS, overall survival; SRS, stereotactic radiosurgery; WBRT, whole brain radiotherapy.

Table 3 Role of gamma knife-based radiosurgery in the treatment of melanoma brain metastases

Study	Patients (n)	One-year LC	One-year OS	Comments
Yu et al^Citation36	122	90%	7 months	Improved survival on multivariate analysis = total intracranial tumor volume < 3 cm^3, inactive systemic disease
Radbill et al^Citation37	51 GKRS alone = 32	81%	26 weeks

Abbreviations: GKRS, gamma knife-based radiosurgery; OS, overall survival.

Figure 1 Iodine¹²⁵ plaque brachytherapy for a patient with an iris melanoma.

Figure 2 Post surgical radiation fields for node positive patients.

Reprinted from Burmeister BH, Mark Smithers B, Burmeister E, et al. A prospective phase II study of adjuvant postoperative radiation therapy following nodal surgery in malignant melanoma–Trans Tasman Radiation Oncology Group (TROG) Study 96.06. Radiother Oncol. 2006;81:136–142. Copyright © 2007, With permission from Elsevier.³⁰

Figure 3 Cell survival signals and potential therapeutic targets for malignant melanoma.

NetworkNCCNCCN Clinical Practice Guidelines in Oncology: Melanoma2010 Available from: http://www.nccn.org/professionals/physician_gls/f_guidelines.aspAccessed June 22, 2011

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