High-dose proton beam therapy for sinonasal mucosal malignant melanoma.

Hiroshi Fuji,Shigeyuki Murayama,Shusuke Yoshikawa,Tetsuro Onitsuka,Yoshio Kiyohara,Masako Kasami,Hiroya Kashiwagi

doi:10.1186/1748-717x-9-162

Abstract

BackgroundThe significance of definitive radiotherapy for sinonasal mucosal melanoma (SMM) is sill controvertial. This study was to evaluate the role of high-dose proton beam therapy (PBT) in patients with SMM.MethodsThe cases of 20 patients with SMM localized to the primary site who were treated by PBT between 2006 and 2012 were retrospectively analyzed. The patterns of overall survival and morbidity were assessed.ResultsThe median follow-up time was 35 months (range, 6–77 months). The 5-year overall and disease-free survival rates were 51% and 38%, respectively. Four patients showed local failure, 2 showed regrowth of the primary tumor, and 2 showed new sinonasal tumors beyond the primary site. The 5-year local control rate after PBT was 62%. Nodal and distant failure was seen in 7 patients. Three grade 4 late toxicities were observed in tumor-involved optic nerve.ConclusionOur findings suggested that high-dose PBT is an effective local treatment that is less invasive than surgery but with comparable outcomes.

Highlights

Sinonasal mucosal melanoma (SMM) is a rare disease accounting for 0.3–2% of all malignant melanomas in North America [1]
Four patients showed local failure at sinonasal site: 2 patients presented with primary tumor progression at 47 and 50 months after proton beam therapy (PBT) and 2 presented with recurrence of melanoma in the sinonasal region beyond the gross tumor volume (GTV) at 19 and 24 months after PBT
The current study showed that the primary disease was controlled in all patients within 3 years

Summary

Introduction

Sinonasal mucosal melanoma (SMM) is a rare disease accounting for 0.3–2% of all malignant melanomas in North America [1]. Its prognosis is much worse than that of cutaneous malignant melanoma; the overall 5-year survival rate of patients with SMM is reported to be 34% [2] whereas that of patients with head and neck cutaneous melanoma is reported to be 80% [3]. For patients with SMM, radiotherapy has been employed for palliation or as adjuvant treatment for surgery. A nationwide survey recently performed in the United States revealed that radiotherapy has a limited role in improving overall patient survival [3]. The significance of definitive radiotherapy for sinonasal mucosal melanoma (SMM) is sill controvertial. This study was to evaluate the role of high-dose proton beam therapy (PBT) in patients with SMM

Methods

Results

Conclusion