Radiotherapy for cutaneous malignant melanoma: rationale and indications.
Radiotherapy for cutaneous malignant melanoma: rationale and indications.
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作者：
M. Ballo;K. Ang
使用放射作为皮肤恶性黑色素瘤患者的辅助治疗一直受到黑色素瘤细胞具有放射抗性这一未经证实的信念的阻碍。大量的文献已经证明，当存在某些临床病理特征时，单纯手术后黑色素瘤局部复发是常见的。与原发性肿瘤复发高风险相关的特征包括促结缔组织增生亚型、显微镜下切缘阳性、复发性疾病和伴有溃疡或钙化的厚原发性病变。与淋巴结复发高风险相关的特征包括囊外扩散、累及4个或更多个淋巴结、淋巴结测量至少3 cm、颈部淋巴结位置和复发性疾病。许多研究支持在这些临床情况下辅助放疗的疗效。虽然文献中的数据仍然稀少，但证据也表明，选择性照射在消除原发性黑色素瘤后的亚临床淋巴结转移方面是有效的。因此，可能有机会将放射治疗整合到亚临床淋巴结疾病高风险患者的多模式治疗中，特别是那些涉及前哨淋巴结的患者。已知此类患者的额外淋巴结受累率较低，因此在这组患者中，短期放疗可能是区域淋巴结清扫术的适当替代品。这将是未来研究的主题。
The use of radiation as adjuvant therapy for patients with cutaneous malignant melanoma has been hindered by the unsubstantiated belief that melanoma cells are radioresistant. An abundance of literature has now demonstrated that locoregional relapse of melanoma is common after surgery alone when certain clinicopathologic features are present. Features associated with a high risk of primary tumor recurrence include desmoplastic subtype, positive microscopic margins, recurrent disease, and thick primary lesions with ulceration or statellitosis. Features associated with a high risk of nodal relapse include extracapsular extension, involvement of four or more lymph nodes, lymph nodes measuring at least 3 cm, cervical lymph node location, and recurrent disease. Numerous studies support the efficacy of adjuvant irradiation in these clinical situations. Although data in the literature remain sparse, evidence also indicates that elective irradiation is effective in eradicating subclinical nodal metastases after removal of the primary melanoma. Consequently, there may be an opportunity to integrate radiotherapy into the multimodality treatment of patients at high risk of subclinical nodal disease, particularly those with an involved sentinel lymph node. Such patients are known to have a low rate of additional lymph node involvement, and thus in this group, a short course of radiotherapy may be an adequate substitute for regional lymph node dissection. This will be the topic of future research.