Malignant melanoma treatment using brachytherapy: Two case reports and 15 case series
Malignant melanoma treatment using brachytherapy: Two case reports and 15 case series
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DOI：
10.1111/1346-8138.16599
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发表时间：
2022-10-04
影响因子：
3.1
通讯作者：
Yamazaki, Naoya
中科院分区：
文献类型：
--
作者：
Ishiguro, Akihiro;Ogata, Dai;Yamazaki, Naoya
恶性黑色素瘤（MM）通常对放疗有抵抗力。近距离放射治疗可能是出血或疼痛患者以及手术困难患者的一种选择。近距离放射治疗副作用小，可与外照射放疗或化疗联合使用。我们总结了在我院接受近距离放射治疗的15例MM患者的人口统计学和临床特征，并描述了其中两例代表性病例。患者1在尿道外口附近有一个约10 mm的暗红色结节。未行切除术以保留尿道功能。在48戈伊远程后装系统（RALS）近距离放射治疗和纳武单抗治疗后观察到逐渐改善。患者2在阴道上有一个38 mm的黑色肿瘤。切除后，RALS近距离放射治疗管理，以治疗残留的黑色斑和病变迅速消失。在所有15例病例中，9例患者接受了局部控制放射治疗，6例患者接受了姑息性放射治疗，以减少出血和疼痛等症状。照射部位为阴道6例，淋巴结转移5例，头颈部2例，皮肤或皮下转移2例，肛门1例。局部控制和姑息治疗的治疗效果分别为75%和83%的患者。特别是，在阴道近距离放射治疗的一半病例中观察到肿瘤消失或症状消失。另一方面，近距离放射治疗对淋巴结转移不是很有效。放疗后立即，8例（53%）患者发生皮炎或粘膜炎。由于腔器官粘膜黑色素瘤的组织学和结构特征，近距离放射治疗可能是一种有效的治疗方法。因此，应考虑在不可切除的MM病例中广泛使用具有适当照射技术的近距离放射治疗，以实现局部控制和姑息治疗。
Malignant melanoma (MM) is usually resistant to radiotherapy. Brachytherapy may be an option in patients with bleeding or pain, and those in whom surgery is difficult. Brachytherapy has few side effects and can be used in combination with external beam radiotherapy or chemotherapy. We summarize the demographic and clinical characteristics of 15 patients who received brachytherapy for MM at our hospital and describe two of these representative cases. Patient 1 had an approximately 10-mm, dark-red nodule near the external urethral meatus. Excision was not performed to preserve urethral function. A gradual improvement was observed after 48 Gy of remote afterloading system (RALS) brachytherapy and nivolumab therapy. Patient 2 had a 38-mm, black tumor on the vagina. Post-resection, RALS brachytherapy was administered to treat the residual black macule and a lesion quickly disappeared. In all 15 cases, nine patients received radiotherapy for local control and six patients received palliative radiotherapy to reduce symptoms such as bleeding and pain. The irradiation site was the vagina in six patients, lymph node metastasis in five, head and neck in two, skin or subcutaneous metastases in two, and the anus in one. Treatment effect for local control and palliative care was 75% and 83% of patients, respectively. In particular, disappearance of the tumor or disappearance of symptoms was observed in half of the cases of brachytherapy to the vagina. On the other hand, brachytherapy was not very effective for lymph node metastases. Immediately after radiotherapy, eight (53%) patients experienced dermatitis or mucositis. Due to the histological and structural characteristics of mucosal melanoma of the luminal organs, brachytherapy may be an effective therapy. Hence, widespread use of brachytherapy with an appropriate irradiation technique aiming for local control and palliative care in case of unresectable MM should be considered.