Vol 15, No 6 (2019)
Review paper
Published online: 2020-01-10
The role of radiotherapy in melanoma
Oncol Clin Pract 2019;15(6):310-319.
Abstract
The role of radiotherapy (RT) in the treatment of melanoma is constantly evolving. Although melanoma is considered
a radioresistant tumour with great potential for repairing sub-lethal damage, RT is an important component
of treatment. Indications for sole or adjuvant radiotherapy of the primary lesion are limited and include desmoplastic
melanoma, the presence of satellite lesions and/or in-transit metastases, the presence of melanoma cells
in blood or lymphatic vessels, infiltration of nerve trunks, recurrence after previous surgery, and locally advanced
melanomas of the head and neck region, especially inoperable. In the past, the most common indication for
radiotherapy in melanoma was adjuvant treatment after lymphadenectomy in patients with risk factors for nodal
recurrence (large metastasis diameter, multiple nodes involved, extracapsular extension). Adjuvant radiotherapy
after lymphadenectomy has been shown to almost double the local control of the disease, but it does not affect
patient survival and may also lead to significant toxicity. Nevertheless, currently the recommended approach is
systemic adjuvant treatment (anti-PD-1 immunotherapy with pembrolizumab or nivolumab and, in the presence of
BRAF mutation, BRAF/MEK inhibitors), and RT should be reserved for situations in which there are contraindications
to other adjuvant treatment. Stereotactic techniques, including radiosurgery of brain metastases, are becoming
more widely used. RT could be a definitive treatment for a limited number of metastases or in cases of limited
progression on systemic treatment. The effectiveness of RT can be increased by combining with hyperthermia. An
increasing number of reports suggest great benefit from the combination of RT with immunotherapy. At present,
there is no convincing evidence supporting the combination of RT with molecularly targeted treatment, and according
to emerging data on the toxicity of such a combination it should be used with caution.
Keywords: melanomaradiotherapy adjuvantimmunotherapyradiotherapy
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