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Cancers
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Radiotherapy in Melanoma
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Radiotherapy in Melanoma

A special issue of Cancers (ISSN 2072-6694). This special issue belongs to the section "Cancer Therapy".

Deadline for manuscript submissions: closed (1 October 2024) | Viewed by 3802

Special Issue Editor

Dr. Evan Wuthrick

E-Mail Website
Guest Editor
Department of Radiation Oncology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL, USA
Interests: anal cancer; basal cell carcinoma; colon cancer; esophageal cancer; liver cancer; Merkel cell carcinoma; pancreatic cancer; rectal cancer; squamous cell carcinoma; stomach (gastric) cancer

Special Issue Information

Dear Colleagues,

Melanoma continues to steadily rise in prevalence, accounts for the majority of skin-cancer-related deaths, and remains a major public health problem. Historically, melanoma was thought to be relatively radiation therapy-resistant, and radiation therapy was thought to be of little use in treating melanoma. However, a growing body of research suggests the usefulness of especially hypo-fractionated and ablative radiation therapy in improving key outcomes. Although surgery remains the mainstay of treatment and immunotherapy has altered the treatment paradigm landscape, radiation therapy may be considered as an adjuvant, consolidative, definitive, or neoadjuvant treatment in some specific patient populations with melanoma. The purpose of this Special Issue is to examine the available data informing the use of radiation therapy in melanoma and to ultimately identify the melanoma patient populations who will derive benefit from radiation therapy.

Dr. Evan Wuthrick
Guest Editor

Manuscript Submission Information

Manuscripts should be submitted online at www.mdpi.com by registering and logging in to this website. Once you are registered, click here to go to the submission form. Manuscripts can be submitted until the deadline. All submissions that pass pre-check are peer-reviewed. Accepted papers will be published continuously in the journal (as soon as accepted) and will be listed together on the special issue website. Research articles, review articles as well as communications are invited. For planned papers, a title and short abstract (about 100 words) can be sent to the Editorial Office for announcement on this website.

Submitted manuscripts should not have been published previously, nor be under consideration for publication elsewhere (except conference proceedings papers). All manuscripts are thoroughly refereed through a single-blind peer-review process. A guide for authors and other relevant information for submission of manuscripts is available on the Instructions for Authors page. Cancers is an international peer-reviewed open access semimonthly journal published by MDPI.

Please visit the Instructions for Authors page before submitting a manuscript. The Article Processing Charge (APC) for publication in this open access journal is 2900 CHF (Swiss Francs). Submitted papers should be well formatted and use good English. Authors may use MDPI's English editing service prior to publication or during author revisions.

Keywords

  • melanoma
  • radiotherapy
  • neoadjuvant treatment

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Published Papers (6 papers)

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Review

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10 pages, 485 KiB  
Review
Adjuvant Radiation Therapy in Desmoplastic Melanoma: A Scoping Review
by Christina Setareh Sharafi, B. Ashleigh Guadagnolo, Kelly C. Nelson and Devarati Mitra
Cancers 2024, 16(22), 3874; https://doi.org/10.3390/cancers16223874 - 19 Nov 2024
Viewed by 275
Abstract
Desmoplastic melanoma (DM) is an uncommon subtype of cutaneous melanoma that presents distinct diagnostic and treatment challenges. This review aims to explore the role of adjuvant radiation therapy (RT) in managing DM. To evaluate this question, we reviewed relevant published reports on DM [...] Read more.
Desmoplastic melanoma (DM) is an uncommon subtype of cutaneous melanoma that presents distinct diagnostic and treatment challenges. This review aims to explore the role of adjuvant radiation therapy (RT) in managing DM. To evaluate this question, we reviewed relevant published reports on DM and its treatment and synthesized these findings. It was found that the clinical behavior of DM varies significantly based on its classification as either “pure” DM (pDM, ≥90% desmoplastic features) or mixed DM (mDM, ≤90% desmoplastic features). Patients with pDM have a uniquely high risk of local recurrence but a relatively lower likelihood of nodal disease. Recent studies question the necessity of sentinel lymph node biopsy for pDM patients while illustrating impressive response rates to immune checkpoint inhibition. Most data supporting adjuvant RT predate these changes in surgical management and systemic therapy, yet consistently demonstrate that adjuvant RT reduces the absolute risk of local recurrence by >50%, without significant long-term toxicity. Thus, the existing literature continues to support the conclusion that adjuvant RT effectively reduces the likelihood of local recurrence in pDM patients. Although evolving surgical and systemic therapies are reshaping treatment approaches, adjuvant RT should remain a standard of care. Full article
(This article belongs to the Special Issue Radiotherapy in Melanoma)
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14 pages, 275 KiB  
Review
Delayed and Concurrent Stereotactic Radiosurgery in Immunotherapy-Naïve Melanoma Brain Metastases
by Christine E. Hadley, Jennifer K. Matsui, Dukagjin M. Blakaj, Sasha Beyer, John C. Grecula, Arnab Chakravarti, Evan Thomas, Raju R. Raval, James B. Elder, Kyle Wu, Kari Kendra, Pierre Giglio and Joshua D. Palmer
Cancers 2024, 16(22), 3733; https://doi.org/10.3390/cancers16223733 - 5 Nov 2024
Viewed by 530
Abstract
Melanoma remains a formidable challenge in oncology, causing the majority of skin cancer deaths in the United States, with brain metastases contributing substantially to this mortality. This paper reviews the current therapeutic strategies for melanoma brain metastases, with a focus on delayed and [...] Read more.
Melanoma remains a formidable challenge in oncology, causing the majority of skin cancer deaths in the United States, with brain metastases contributing substantially to this mortality. This paper reviews the current therapeutic strategies for melanoma brain metastases, with a focus on delayed and concurrent stereotactic radiosurgery (SRS). While surgery and traditional chemotherapy offer limited efficacy, recent advances in immunotherapy, particularly immune checkpoint inhibitors (ICIs), have played a major role in the advancement and improved efficacy of the treatment of cancers, including brain metastases. Recent studies indicate that monotherapy with ICIs may lead to a higher median overall survival compared to historical benchmarks, potentially allowing patients to delay radiosurgery. Other studies have found that combining SRS with ICIs demonstrates promise, with results indicating improved intracranial control. Ongoing clinical trials explore novel combinations of immunotherapies and radiotherapies, aiming to optimize treatment outcomes while minimizing adverse effects. As treatment options expand, future studies will be necessary to understand the interplay between therapies and their optimal sequencing to improve patient outcomes. Full article
(This article belongs to the Special Issue Radiotherapy in Melanoma)
12 pages, 1308 KiB  
Review
Proton Therapy in Uveal Melanoma
by Adrian Wai Chan, Haibo Lin, Irini Yacoub, Arpit M. Chhabra, J. Isabelle Choi and Charles B. Simone 2nd
Cancers 2024, 16(20), 3497; https://doi.org/10.3390/cancers16203497 - 16 Oct 2024
Viewed by 830
Abstract
Background/Objectives: Uveal melanoma is the most common primary intraocular malignancy in adults. Treatment options for localized, early-stage disease include enucleation, brachytherapy, and proton beam therapy. This review aims to evaluate the role of proton therapy in the definitive management of uveal melanoma, focusing [...] Read more.
Background/Objectives: Uveal melanoma is the most common primary intraocular malignancy in adults. Treatment options for localized, early-stage disease include enucleation, brachytherapy, and proton beam therapy. This review aims to evaluate the role of proton therapy in the definitive management of uveal melanoma, focusing on its physics, radiobiology, treatment techniques, and associated outcomes. Methods: This narrative review synthesizes current literature on proton therapy for uveal melanoma, emphasizing case selection, treatment efficacy, and side effects. Results: Proton therapy offers significant advantages for thicker uveal melanomas (over 8 mm) due to its unique physical properties, including a rapid dose fall-off that protects critical structures like the retina and optic nerve. Proton therapy may have benefits in tumor control for ocular melanomas given its increased relative biological effectiveness relative to photon therapy for these typically more radioresistant melanomas. Proton therapy may also hold special value for uveal melanomas in close proximity to the optic nerve, as patients are at high risk of visual toxicities with brachytherapy. The review discusses the efficacy of proton therapy across small, medium, and large tumors, along with strategies for improving patient survival through combined systemic therapy. Additionally, the potential of ocular reirradiation with proton therapy is addressed. Conclusions: Proton therapy is an effective treatment for uveal melanoma. It offers advantages over brachytherapy for large tumors, tumors that are close to the optic nerve or insertion of extra-ocular muscles. Full article
(This article belongs to the Special Issue Radiotherapy in Melanoma)
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10 pages, 622 KiB  
Review
Radiation Therapy in the Management of Head and Neck Mucosal Melanoma
by Omar Azem, Omar Nabulsi, Michael Jelinek and Nikhil Joshi
Cancers 2024, 16(19), 3304; https://doi.org/10.3390/cancers16193304 - 27 Sep 2024
Viewed by 667
Abstract
Mucosal melanoma of the head and neck (HNMM) is a rare but highly aggressive malignancy, often diagnosed at an advanced stage with poor prognosis. This review discusses current treatment strategies, emphasizing the role of radiotherapy in managing this challenging disease. A comprehensive analysis [...] Read more.
Mucosal melanoma of the head and neck (HNMM) is a rare but highly aggressive malignancy, often diagnosed at an advanced stage with poor prognosis. This review discusses current treatment strategies, emphasizing the role of radiotherapy in managing this challenging disease. A comprehensive analysis of 33 studies provides updated information on techniques and outcomes, highlighting the consistent benefit of adjuvant radiation in improving local control. Advances in conformal techniques, such as intensity-modulated radiotherapy (IMRT), have significantly reduced toxicity rates. Preliminary data on proton and carbon ion therapies suggest the potential for further enhancement of the therapeutic ratio, despite limited availability. Although recent studies report 3-year local control rates as high as 90%, overall survival within the same time frame remains well below 50–60%, underscoring the need for continued improvement in systemic therapies to address the persistent issue of distant metastases. Full article
(This article belongs to the Special Issue Radiotherapy in Melanoma)
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13 pages, 1426 KiB  
Review
Evidence for Radiation Therapy in Stage III Locoregionally Advanced Cutaneous Melanoma in the Post-Immunotherapy Era: A Literature Review
by Jennifer Zhou and Evan Wuthrick
Cancers 2024, 16(17), 3027; https://doi.org/10.3390/cancers16173027 - 30 Aug 2024
Viewed by 732
Abstract
In the landscape of Stage III locoregionally advanced cutaneous melanoma treatment, the post-immunotherapy era has sparked a number of questions on the management of the nodal basin. However, much of the available literature is not focused on radiation therapy as an adjuvant therapy. [...] Read more.
In the landscape of Stage III locoregionally advanced cutaneous melanoma treatment, the post-immunotherapy era has sparked a number of questions on the management of the nodal basin. However, much of the available literature is not focused on radiation therapy as an adjuvant therapy. This literature review aims to illuminate the evidence surrounding radiation therapy’s potential to mitigate regional recurrences in the adjuvant setting for melanoma. Additionally, it seeks to identify adjunct systemic therapy options and explore the synergy between systemic therapy and radiation. Despite strides in surgical techniques and systemic therapies, controlling regional Stage III melanoma remains a formidable clinical hurdle. While historical data strongly suggest the efficacy of adjuvant radiation therapy in reducing regional recurrence risk, its evaluation predates the advent of MAPK pathway inhibitors and robust immunotherapy options. Notably, clinical trials have yet to definitively demonstrate a survival advantage with adjuvant radiation therapy. Additional research should focus on refining the definition of high risk for regional recurrence through gene expression profiling or tumor immune profiling scores and elucidate the optimal role of adjuvant radiation therapy in patients treated with neoadjuvant systemic therapy. Full article
(This article belongs to the Special Issue Radiotherapy in Melanoma)
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8 pages, 877 KiB  
Perspective
Adjuvant Radiation Therapy in Macroscopic Regional Nodal Melanoma
by Gerald B. Fogarty
Cancers 2024, 16(23), 3950; https://doi.org/10.3390/cancers16233950 - 25 Nov 2024
Viewed by 198
Abstract
Adjuvant radiation therapy (ART) for macroscopic regional nodal cutaneous melanoma has evolved. A significant step was the discovery of targeted therapies, particularly towards V600E-mutated melanoma, and immunotherapy under its different kinds. Prior to this, the defining trial was the Australia and New Zealand [...] Read more.
Adjuvant radiation therapy (ART) for macroscopic regional nodal cutaneous melanoma has evolved. A significant step was the discovery of targeted therapies, particularly towards V600E-mutated melanoma, and immunotherapy under its different kinds. Prior to this, the defining trial was the Australia and New Zealand Melanoma Trials Group (ANZMTG) 01.02/Trans-Tasman Radiation Oncology Group (TROG) 02.01 phase III trial that showed that ART using three-dimensional conformal radiotherapy (3DCRT) decreased in-field recurrence by 50% (48 Gray (Gy) in 20 fractions). After the advent of systemic therapies, a trial of the combination targeted therapy of dabrafenib plus trametinib toward BRAF V600-mutant nodal cutaneous melanoma showed that all 35 patients achieved a pathological response. Radiotherapy (RT) was found to be safe to give with concurrent combination therapy. A retrospective immunotherapy study found that in 71 patients that received ART after a first recurrence, further in-field recurrence significantly decreased (p = 0.01). For those tumours that do recur in-field, there are now competing therapies like Talimogene laherparepvec or T-VEC. Generally, ART is now used at the first recurrence. The challenge now is to find which melanomas are truly radiosensitive if ART is to have any future role in this scenario. Full article
(This article belongs to the Special Issue Radiotherapy in Melanoma)
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