Zhou Jennifer, Wuthrick Evan
Morsani College of Medicine, University of South Florida, Tampa, FL 33602, USA.
Department of Radiation, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL 33612, USA.
Cancers (Basel). 2024 Aug 30;16(17):3027. doi: 10.3390/cancers16173027.
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.
在Ⅲ期局部晚期皮肤黑色素瘤的治疗领域，免疫治疗时代引发了一系列关于区域淋巴结治疗的问题。然而，现有文献大多未聚焦于放射治疗作为辅助治疗的情况。这篇文献综述旨在阐明关于放射治疗在黑色素瘤辅助治疗中减轻区域复发可能性的相关证据。此外，它试图确定辅助性全身治疗方案，并探索全身治疗与放射治疗之间的协同作用。尽管手术技术和全身治疗取得了进展，但控制Ⅲ期局部黑色素瘤仍然是一个严峻的临床挑战。虽然历史数据有力地表明辅助放射治疗在降低区域复发风险方面的有效性，但其评估早于MAPK通路抑制剂和强大的免疫治疗方案出现的时间。值得注意的是，临床试验尚未明确证明辅助放射治疗具有生存优势。进一步的研究应集中于通过基因表达谱分析或肿瘤免疫谱评分来完善区域复发高风险的定义，并阐明辅助放射治疗在接受新辅助全身治疗的患者中的最佳作用。
