Harwood A R, Lawson V G
Head Neck Surg. 1982 Jul-Aug;4(6):468-74. doi: 10.1002/hed.2890040605.
This report reviews experience with radiation therapy in 77 patients with melanoma of the head and neck, a lesion traditionally but incorrectly considered to be radiation-resistant. Thirteen patients with lentigo malignum and 18 patients with lentigo malignum melanoma have been primarily irradiated. In 11 of the 13 patients, the lentigo malignum has been locally controlled with no recurrence from 6 months to 5 years following treatment. One patient had a local recurrence and was salvaged with further radiation therapy, and one patient had residual tumor after irradiation and was salvaged with simple excision. Seventeen of 18 patients primarily irradiated had lentigo malignum melanomas that have been locally controlled from 6 months to 6 years after irradiation. One patient had a local recurrence and was salvaged by excisional surgery. There have been no deaths from lentigenous melanoma, and the cosmetic results of treatment are excellent. We concluded that radiation therapy is a simple, effective out-patient treatment for lentigo maligna and lentigo maligna melanoma. Nonlentigenous melanoma was irradiated after incisional biopsy in 6 patients; local control was obtained in 4 patients although 1 died of distant metastases. Fifteen patients were irradiated after excisional biopsy (margins inadequate); 14 of 15 had local control although 6 died of metastases. Only 2 of 16 patients irradiated for recurrent melanoma were controlled. Analysis of local control versus irradiation fraction size revealed that 17/24 (71%) achieved local control with a dose per fraction of greater than 400 rad as compared with 3 of 12 (25%) in those being irradiated with a dose of less than 400 rad per fraction. We concluded that nonlentigenous melanoma is not radiation resistant and that local excision followed by radiation therapy with a large dose per fraction deserves further study, particularly in melanomas of the head and neck where wide local excision is not possible due to age of the patient or location of the tumor. Nine mucosal melanomas have primarily irradiated and four have been locally controlled.
本报告回顾了77例头颈部黑色素瘤患者接受放射治疗的经验，头颈部黑色素瘤这一病变传统上但错误地被认为对放射治疗具有抗性。13例恶性雀斑和18例恶性雀斑黑色素瘤患者接受了根治性放疗。13例患者中有11例，恶性雀斑在治疗后6个月至5年实现了局部控制且无复发。1例患者出现局部复发，通过进一步放疗挽救；1例患者放疗后有残留肿瘤，通过单纯切除挽救。18例接受根治性放疗的患者中有17例，其恶性雀斑黑色素瘤在放疗后6个月至6年实现了局部控制。1例患者出现局部复发，通过切除手术挽救。恶性雀斑黑色素瘤患者无一例死亡，治疗的美容效果极佳。我们得出结论，放射治疗是治疗恶性雀斑和恶性雀斑黑色素瘤的一种简单、有效的门诊治疗方法。6例非恶性雀斑黑色素瘤患者在切开活检后接受放疗；4例患者实现了局部控制，尽管1例死于远处转移。15例患者在切除活检（切缘不充分）后接受放疗；15例中有14例实现了局部控制，尽管6例死于转移。16例复发性黑色素瘤患者接受放疗，只有2例得到控制。局部控制与照射分次剂量的分析显示，每次剂量大于400拉德时，24例中有17例（71%）实现了局部控制，而每次剂量小于400拉德的12例中只有3例（25%）。我们得出结论，非恶性雀斑黑色素瘤并非对放射治疗具有抗性，局部切除后采用大分次剂量放疗值得进一步研究，尤其是在头颈部黑色素瘤中，由于患者年龄或肿瘤位置，无法进行广泛局部切除。9例黏膜黑色素瘤患者接受了根治性放疗，4例实现了局部控制。
