Radioterapia chorych na czerniaka

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.