Melanoma

[clinonc]

I work in the UK. Melanoma is dealt with here largely by medical oncologists (I don't know why - none of the drugs work!) and surgeons. Clinical (radiation) oncologists such as myself sometimes get asked to irradiate brains and particularly unpleasant local or metastatic disease, without much enthusiasm on the part of the referrer. This of course harks back to the widely-held opinion that melanoma is 'radioresistant.' The reality is, of course, that some patients benefit and some don't. It has got me to wondering what US practice is like: do you get many referrals, are they predominantly in the adjuvant or metastatic setting, what range of doses and fractionation schedules do you use, what's your anecdotal/institutional experience of efficacy? Any thoughts welcome.

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[Brim]

In the US, most radiation tx for melanoma is for brain mets or other mets. We do get referrals for adjuvant RT to nodal basins + surgical bed.

For adjuvant RT, I most commonly use the MD Anderson fractionation of 6 Gy x 5 twice weekly. Other times I'll do std fractionation to 50 Gy. For brain mets + other mets I'll usually stick to 30 Gy / 10.

RT is efficacious, but melanoma sucks no matter what you do.

 

[medgator]

In the US, most radiation tx for melanoma is for brain mets or other mets. We do get referrals for adjuvant RT to nodal basins + surgical bed.

For adjuvant RT, I most commonly use the MD Anderson fractionation of 6 Gy x 5 twice weekly. Other times I'll do std fractionation to 50 Gy. For brain mets + other mets I'll usually stick to 30 Gy / 10.

RT is efficacious, but melanoma sucks no matter what you do.

Now with the recent ASTRO plenary abstract presentation, you've got some randomized data to back you up as well. IIRC, I think they used 50 Gy/20 Fx, although I don't have access to the abstract at the moment.

 

[Gfunk6]

We use the Overgaard protocol of hypofrac 8 Gy + hyperthermia. Works very well for palliation of mets and in-transit mets.

PMID: 19670088

 

[deleted4401]

Very rarely currently.
Perhaps Australian data from ASTRO 2009 will change patterns of care.
I get the feeling that melanoma recurrences are bad, and even though survival is not lengthened, prevention of recurrence may be worthwhile.
S