Case Western Reserve University School of Medicine, Cleveland, OH 44106, USA.
Int J Radiat Oncol Biol Phys. 2011 Jul 1;80(3):645-54. doi: 10.1016/j.ijrobp.2010.12.071. Epub 2011 Apr 12.
The incidence of melanoma is rising in the United States, leading to an estimated 68,720 new diagnoses and 8,650 deaths annually. The natural history involves metastases to lymph nodes, lung, liver, brain, and often to other sites. Primary treatment for melanoma is surgical excision of the primary tumor and affected lymph nodes. The role of adjuvant or definitive radiation therapy in the treatment of melanoma remains controversial, because melanoma has traditionally been viewed as a prototypical radioresistant cancer. However, recent studies suggest that under certain clinical circumstances, there may be a significant role for radiation therapy in melanoma treatment. Stereotactic radiosurgery for brain metastases has shown effective local control. High dose per fraction radiation therapy has been associated with a lower rate of locoregional recurrence of sinonasal melanoma. Plaque brachytherapy has evolved into a promising alternative to enucleation at the expense of moderate reduction in visual acuity. Adjuvant radiation therapy following lymphadenectomy in node-positive melanoma prevents local and regional recurrence. The newer clinical data along with emerging radiobiological data indicate that radiotherapy is likely to play a greater role in melanoma management and should be considered as a treatment option.
在美国，黑色素瘤的发病率正在上升，预计每年有 68720 例新诊断病例和 8650 例死亡病例。其自然病程涉及淋巴结、肺、肝、脑转移，且常转移至其他部位。黑色素瘤的主要治疗方法是手术切除原发肿瘤和受累淋巴结。辅助或确定性放疗在黑色素瘤治疗中的作用仍存在争议，因为黑色素瘤一直被视为典型的放射抗拒性癌症。然而，最近的研究表明，在某些临床情况下，放疗在黑色素瘤治疗中可能具有重要作用。立体定向放射外科治疗脑转移瘤可有效控制局部。大剂量分次放疗与较低的鼻腔鼻窦黑色素瘤局部区域复发率相关。放射性敷贴治疗已发展成为一种有前途的眼眶内容剜除术替代方法，其代价是中度视力下降。淋巴结阳性黑色素瘤淋巴结清扫术后的辅助放疗可预防局部和区域复发。新的临床数据以及新兴的放射生物学数据表明，放疗可能在黑色素瘤的管理中发挥更大的作用，应被视为一种治疗选择。
