Bauer Lukas, Paul Angela, Regnery Sebastian, Deng Maximilian Y, Ellerbrock Malte, Mielke Thomas, Harrabi Semi B, Seidensaal Katharina, Held Thomas, Herfarth Klaus, Debus Jürgen, Hassel Jessica C, Uzun-Lang Kristin
Department of Radiation Oncology, Heidelberg University Hospital, Heidelberg, Germany.
Heidelberg Institute of Radiation Oncology (HIRO), Heidelberg, Germany.
Front Oncol. 2024 Nov 22;14:1437412. doi: 10.3389/fonc.2024.1437412. eCollection 2024.
Due to the rarity of mucosal melanomas, few recent studies can be found investigating the success and side effects of therapy for this entity with large numbers of patients. In this retrospective analysis, the efficacy and toxicity of combined intensity-modulated radiotherapy (IMRT) and carbon ion therapy (C12) of mucosal melanomas were analyzed to contribute to a better understanding of this rare disease.
Twenty-two patients were included from 2013 to 2022 in the Department of Radiation Oncology at Heidelberg University Hospital. 19 patients received bimodal radiotherapy consisting of radiotherapy by IMRT and carbon ion therapy (C12). 3 patients received photon only IMRT. In addition to Overall Survival (OS), local control rate (LCR), locoregional control rate (LRCR) and progression-free survival (PFS), early and late toxicity of treatment was analyzed. Bimodal radiotherapy consisted of IMRT of the primary tumor region and cervical lymph nodes in a single dose of 2 Gy up to the dose of 50.0 Gy in the basic schedule after application of a C12 boost of the primary tumor region up to 24 Gy (RBE) in a single dose of 3 Gy (RBE) up to the total dose of 74.0 Gy (RBE) in 5-6 fractions/week. Photon only radiotherapy comprised IMRT up to total doses of 66-70,4 Gy in 5 fractions/week.
After 2 years, overall survival, progression-free survival, local control and locoregional control were 46%, 41%, 77% and 77%, respectively. 4 out of 5 patients with local relapse showed in-field recurrence inside the C12 boost volume. The primary tumor in these patients was always located in the main nasal cavity and/or paranasal sinus. Leading acute toxicity was grade 2 mucositis (12 patients, 55%) followed by grade 1 radiation dermatitis (10 patients, 45%). The cumulative incidence of late grade 3 toxicities was 15%.
The combination of IMRT with carbon ion therapy in the treatment of mucosal melanoma provides promising local control rates with mild acute toxicity despite unfavorable patient preselection. The unfavorable overall survival as well as progression-free survival rates indicate that concomitant systemic therapies should be the subject of future research.
由于黏膜黑色素瘤罕见，近期很少有研究对大量患者进行该疾病治疗的疗效和副作用调查。在这项回顾性分析中，分析了黏膜黑色素瘤的调强放射治疗（IMRT）与碳离子治疗（C12）联合应用的疗效和毒性，以助于更好地了解这种罕见疾病。
2013年至2022年期间，海德堡大学医院放射肿瘤学系纳入了22例患者。19例患者接受了由IMRT和碳离子治疗（C12）组成的双峰放疗。3例患者仅接受光子IMRT。除了总生存期（OS）、局部控制率（LCR）、区域控制率（LRCR）和无进展生存期（PFS）外，还分析了治疗的早期和晚期毒性。双峰放疗包括对原发肿瘤区域和颈部淋巴结进行IMRT，单次剂量2 Gy，基础方案中总剂量达50.0 Gy，之后对原发肿瘤区域进行C12增强放疗，单次剂量3 Gy（相对生物效应剂量，RBE），总剂量达24 Gy（RBE），每周5 - 6次，总剂量达74.0 Gy（RBE）。仅光子放疗包括每周5次的IMRT，总剂量达66 - 70.4 Gy。
2年后，总生存期、无进展生存期、局部控制率和区域控制率分别为46%、41%、77%和77%。5例局部复发患者中有4例在C12增强体积内出现野内复发。这些患者的原发肿瘤总是位于鼻腔主要部位和/或鼻窦。主要的急性毒性是2级黏膜炎（12例患者，55%），其次是1级放射性皮炎（10例患者，45%）。晚期3级毒性的累积发生率为15%。
IMRT与碳离子治疗联合用于黏膜黑色素瘤的治疗，尽管患者选择不佳，但仍能提供有前景的局部控制率且急性毒性较轻。总体生存率和无进展生存率不佳表明，联合全身治疗应成为未来研究的主题。
