Skip to main content
SpringerLink
Log in

Radiotherapie des kutanen malignen Melanoms

Radiation therapy of cutaneous malignant melanoma

  • Leitthema
  • Published:
Der Onkologe Aims and scope

Zusammenfassung

Hintergrund

Das Melanom galt früher als strahlenresistenter Tumor. Publikationen der letzten 20 Jahre konnten zeigen, dass die Radiotherapie in der primären und in der Rezidivsituation sowie auch bei Metastasen einen wichtigen therapeutischen Beitrag leisten kann.

Material und Methode

Diese Arbeit basiert auf einer selektiven Literaturrecherche in der Datenbank PubMed zum Thema „Radiotherapie und Melanom“.

Ergebnisse und Schlussfolgerung

Die Radiotherapie nimmt bei der definitiven Behandlung kutaner Melanome eher eine untergeordnete Rolle ein. Eine Ausnahme stellt das Lentigo-maligna-Melanom dar, wo sich bei Patienten, die nicht operabel sind, durch eine Bestrahlung sehr gute lokale Kontrollraten erzielen lassen. In der postoperativen Situation kann bei R1- oder R2-resezierten Tumoren bzw. bei knapp resezierten desmoplastischen Tumoren eine Bestrahlung mit dem Ziel der lokalen Kontrolle durchgeführt werden. Bei Vorliegen von Risikofaktoren (Zahl und Größe der befallenen Lymphknoten, Kapseldurchbruch, Rezidiv) sollte eine adjuvante Bestrahlung der Lymphknotenregion erfolgen, um die lokale Tumorkontrollrate zu erhöhen. Bei Vorliegen von symptomatischen Knochenmetastasen lassen sich die Beschwerden durch eine palliative Radiotherapie gut kontrollieren. Bei der Behandlung einer Hirnmetastasierung sollte eine lokale Radiotherapie (z. B. Radiochirurgie) der Ganzhirnbestrahlung vorgezogen werden. Dabei kann eine Radiotherapie mit Ipilimumab auch simultan kombiniert werde; eine Kombination mit BRAF-Inhibitoren sollte dagegen sequenziell erfolgen.

Abstract

Background

In the past melanoma was considered intrinsically resistant to radiotherapy. In the last two decades radiotherapy was shown to be effective in the treatment of primary and recurrent tumors as well as in metastatic situations.

Material and methods

This review is based on a PubMed search of the medical subject heading terms “radiotherapy and melanoma”.

Results and conclusion

Radiotherapy does not play an important role in the definitive treatment of cutaneous melanoma. An exception is medically inoperable patients with lentigo maligna, where definitive radiotherapy offers a treatment option with good local control rates. Postoperative radiotherapy reduces the risk of recurrence in patients with positive margins and in patients with desmoplastic melanoma and closed margins. Radiotherapy of the nodal basis should be considered in high-risk patients (size and number of involved nodes, extranodal spread, lymph node relapse). Palliative radiotherapy can effectively reduce the symptoms in patients with bone metastases. Local radiosurgery should be preferred to whole brain radiotherapy. Radiotherapy may be simultaneously combined with ipilimumab but should be combined with BRAF inhibitors only sequentially.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Literatur

  1. Agrawal S, Kane JM, Guadagnolo BA et al (2009) The benefits of adjuvant radiation therapy after therapeutic lymphadenectomy for clinically advanced, high-risk, lymph node-metastatic melanoma. Cancer 115(24):5836–5844

    Article  PubMed  Google Scholar 

  2. Anker CJ, Ribas A, Grossmann AH et al (2013) Severe liver and skin toxicity after radiation and vemurafenib in metastatic melanoma. J Clin Oncol 31(17):e283–e287

    Article  PubMed  Google Scholar 

  3. Anker CJ, Grossmann KF, Atkins MB et al (2016) Avoiding severe toxicity from combined BRAF inhibitor and radiation treatment: consensus guidelines from the eastern cooperative oncology group (ECOG). Int J Radiat Oncol Biol Phys 95(2):632–646

    Article  PubMed  PubMed Central  CAS  Google Scholar 

  4. Bibault JE, Dewas S, Mirabel X et al (2011) Adjuvant radiation therapy in metastatic lymph nodes from melanoma. Radiat Oncol 6:12

    Article  PubMed  PubMed Central  Google Scholar 

  5. Brown PD, Jaeckle K, Ballman KV et al (2016) Effect of radiosurgery alone vs radiosurgery with whole brain radiation therapy on cognitive function in patients with 1 to 3 brain metastases: a randomized clinical trial. JAMA 316(4):401–409

    Article  PubMed  PubMed Central  Google Scholar 

  6. Burmeister BH, Henderson MA, Ainslie J et al (2012) Adjuvant radiotherapy versus observation alone for patients at risk of lymph-node field relapse after therapeutic lymphadenectomy for melanoma: a randomised trial. Lancet Oncol 13:589–597

    Article  PubMed  Google Scholar 

  7. Chen JY, Hruby G, Scolyer RA et al (2008) Desmoplastic neurotropic melanoma: a clinicopathologic analysis of 128 cases. Cancer 113(10):2770–2778

    Article  PubMed  Google Scholar 

  8. Choong ES, Lo S, Drummond M, Fogarty GB et al (2017) Survival of patients with melanoma brain metastasis treated with stereotactic radiosurgery and active systemic drug therapies. Eur J Cancer 75:169–178

    Article  PubMed  CAS  Google Scholar 

  9. Creagan ET, Cupps RE, Ivins JC et al (1978) Adjuvant radiation therapy for regional nodal metastases from malignant melanoma: a randomized, prospective study. Cancer 42:2206–2210

    Article  PubMed  CAS  Google Scholar 

  10. Eigentler TK, Figl A, Krex D et al (2011) Number of metastases, serum lactate dehydrogenase level, and type of treatment are prognostic factors in patients with brain metastases of malignant melanoma. Cancer 117:1697–1703

    Article  PubMed  Google Scholar 

  11. Farshad A, Burg G, Panizzon R et al (2002) A retrospective study of 150 patients with lentigo maligna and lentigo maligna melanoma and the efficacy of radiotherapy using Grenz or soft X‑rays. Br J Dermatol 146(6):1042–1046

    Article  PubMed  CAS  Google Scholar 

  12. Fife KM, Colman MH, Stevens GN et al (2004) Determinants of outcome in melanoma patients with cerebral metastases. J Clin Oncol 22(7):1293–1300

    Article  PubMed  CAS  Google Scholar 

  13. Fogarty G, Morton RL, Vardy J et al (2011) Whole brain radiotherapy after local treatment of brain metastases in melanoma patients – a randomised phase III trial. BMC Cancer 11:142

    Article  PubMed  PubMed Central  Google Scholar 

  14. Gojkovič-Horvat A, Jančar B, Blas M et al (2012) Adjuvant radiotherapy for palpable melanoma metastases to the groin: when to irradiate? Int J Radiat Oncol Biol Phys 83:310–316

    Article  PubMed  Google Scholar 

  15. Goyal S, Silk AW, Tian S ( et al (2015) Clinical management of multiple melanoma brain metastases: a systematic review. JAMA Oncol 1(5):668–676

    Article  Google Scholar 

  16. Hamming-Vrieze O, Balm AJ, Heemsbergen WD et al (2009) Regional control of melanoma neck node metastasis after selective neck dissection with or without adjuvant radiotherapy. Arch Otolaryngol Head Neck Surg 135:795–800

    Article  PubMed  Google Scholar 

  17. Katz HR (1981) The results of different fractionation schemes in the palliative irradiation of metastatic melanoma. Int J Radiat Oncol Biol Phys 7:907–911

    Article  PubMed  CAS  Google Scholar 

  18. Kocher M, Soffietti R, Abacioglu U et al (2011) Adjuvant whole-brain radiotherapy versus observation after radiosurgery or surgical resection of one to three cerebral metastases: results of the EORTC 22952-26001 study. J Clin Oncol 29(2):134–141

    Article  PubMed  Google Scholar 

  19. Lobo PA, Liebner EJ, Chao JJ et al (1981) Radiotherapy in the management of malignant melanoma. Int J Radiat Oncol Biol Phys 7:21–26

    Article  PubMed  CAS  Google Scholar 

  20. Ly D, Bagshaw HP, Anker CJ et al (2015) Local control after stereotactic radiosurgery for brain metastases in patients with melanoma with and without BRAF mutation and treatment. J Neurosurg 123(2):395–401

    Article  PubMed  CAS  Google Scholar 

  21. Mornex F, Thomas L, Mohr P et al (2003) A prospective randomized multicentre phase III trial of fotemustine plus whole brain irradiation versus fotemustine alone in cerebral metastases of malignant melanoma. Melanoma Res 13(1):97–103

    Article  PubMed  CAS  Google Scholar 

  22. O’Brien CJ, Petersen-Schaefer K, Stevens GN et al (1997) Adjuvant radiotherapy following neck dissection and parotidectomy for metastatic malignant melanoma. Head Neck 19:589–594

    Article  PubMed  Google Scholar 

  23. Olivier KR, Schild SE, Morris CG et al (2007) A higher radiotherapy dose is associated with more durable palliation and longer survival in patients with metastatic melanoma. Cancer 15:1791–1795

    Article  Google Scholar 

  24. Peuvrel L, Ruellan AL, Thillays F et al (2013) Severe radiotherapy-induced extracutaneous toxicity under vemurafenib. Eur J Dermatol 23(6):879–881

    PubMed  Google Scholar 

  25. Pflugfelder A, Kochs C, Blum A et al (2013) Malignant melanoma S3-guideline “diagnosis, therapy and follow-up of melanoma. J Dtsch Dermatol Ges 11(Suppl 6):1–116, 1–126

    PubMed  Google Scholar 

  26. Raizer JJ, Hwu WJ, Panageas KS et al (2008) Brain and leptomeningeal metastases from cutaneous melanoma: survival outcomes based on clinical features. Neuro Oncol 10(2):199–207

    Article  PubMed  PubMed Central  Google Scholar 

  27. Rule WG, Allred JB, Pockaj BA et al (2016) Results of NCCTG N0275 (Alliance) – a phase II trial evaluating resection followed by adjuvant radiation therapy for patients with desmoplastic melanoma. Cancer Med 5(8):1890–1896

    Article  PubMed  PubMed Central  CAS  Google Scholar 

  28. Sambade MJ, Peters EC, Thomas NE et al (2011) Melanoma cells show a heterogeneous range of sensitivity to ionizing radiation and are radiosensitized by inhibition of B‑RAF with PLX-4032. Radiother Oncol 98(3):394–399

    Article  PubMed  PubMed Central  CAS  Google Scholar 

  29. Seegenschmiedt MH, Keilholz L, Pieritz A et al (1999) Locally recurrent and metastatic malignant melanoma. Long-term results and prognostic factors after percutaneous radiotherapy. Strahlenther Onkol 175(9):450–457

    Article  PubMed  CAS  Google Scholar 

  30. Seegenschmiedt MH, Keilholz L, Altendorf-Hofmann A et al (1999) Palliative radiotherapy for recurrent and metastatic malignant melanoma: prognostic factors for tumor response and long-term outcome: a 20-year experience. Int J Radiat Oncol Biol Phys 44:607–618

    Article  PubMed  CAS  Google Scholar 

  31. Shen P, Wanek LA, Morton DL (2000) Is adjuvant radiotherapy necessary after positive lymph node dissection in head and neck melanomas? Ann Surg Oncol 7:554–559

    Article  PubMed  CAS  Google Scholar 

  32. Sperduto PW, Chao ST, Sneed PK et al (2010) Diagnosis-specific prognostic factors, indexes, and treatment outcomes for patients with newly diagnosed brain metastases: a multi-institutional analysis of 4,259 patients. Int J Radiat Oncol Biol Phys 77:655–661

    Article  PubMed  Google Scholar 

  33. Strojan P, Jancar B, Cemazar M et al (2010) Melanoma metastases to the neck nodes: role of adjuvant irradiation. Int J Radiat Oncol Biol Phys 77:1039–1045

    Article  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Klinik und Poliklinik für Strahlentherapie, Universitätsklinikum Regensburg, Franz-Josef Strauß Allee 11, 93051, Regensburg, Deutschland

    O. Kölbl

Authors
  1. O. Kölbl
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to O. Kölbl.

Ethics declarations

Interessenkonflikt

O. Kölbl gibt an, dass kein Interessenkonflikt besteht.

Dieser Beitrag beinhaltet keine von den Autoren durchgeführten Studien an Menschen oder Tieren.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Kölbl, O. Radiotherapie des kutanen malignen Melanoms. Onkologe 24, 484–488 (2018). https://doi.org/10.1007/s00761-018-0375-2

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00761-018-0375-2

Schlüsselwörter

Keywords

Search

Navigation