Carbon Ion Radiotherapy for Mucosal Malignant Melanoma of the Head and Neck

1
Carbon Ion Radiotherapy for Mucosal Malignant
Melanoma of the Head and Neck

• Department of Radiology
• Hyogo Ion Beam Medical Center
• Hyogo, JAPAN

Kazufumi KAGAWA, Hiroshi MAYAHARA,
Yasue ODA, Atsuya KAWAGUCHI, Masao MURAKAMI,
Yoshio HISHIKAWA, Mitsuyuki ABE
2

• Purpose To evaluate the efficiency and toxicity
  of carbon ion radiotherapy (RT) for mucosal
  malignant melanoma of the head and neck.
• Methods and Materials Between February and
  July in 2002, eight patients with mucosal
  malignant melanoma of the head and neck were
  treated by carbon ion RT. Total tumor dose was
  57.6 GyE/16 fractions/4 weeks. Primary tumor
  sites and corresponding T-stages were as follows
  nasal cavity/ethmoid sinus/hard palate 5/2/1,
  T1/T2/T3/T4 1/2/2/3. Pretreatment FDG-PET
  showed no distant metastasis in all patients.
  The patients were followed for a median period of
  24 months (range 5-39 months).
• Results All patients completed intended
  treatment. Eight patients (100) reached gt50
  tumor regression within 3 months. The 2-year
  local control rate was 100. Within 8 months, 6
  patients (75) developed distant metastases. The
  2-year disease-free and overall survival rates
  were 25 and 50, respectively. Most recurrent
  diseases were multiple metastases and became
  fatal. Acute toxicities classified by the
  NCI-CTC 2.0 were Grade 2 in the skin (n 4),
  Grade 3 in the oral mucosa (n 5), and Grade 2
  in the nasal mucosa (n 5), which were all
  tolerable and healed within 2 months. All
  patients continued oral feeding during the
  treatment course. Late toxicities classified by
  the RTOG/EORTC scoring system were Grade 1 in the
  skin (n 3) and Grade 1 in the nasal mucosa (n
  5).
• Conclusions Carbon ion RT is very effective
  for local control of mucosal malignant melanoma
  of the head and neck. As for distant metastasis,
  however, even early cases developed multiple
  metastases after local control of the primary
  tumor sites. The current multidrug chemotherapy
  has limited effects on disseminated diseases.

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• Patient characteristics

DAV multidrug chemotherapy with DTIC, ACNU,
VCR RND radical neck dissection
4
Acute reactions of the oral mucosa
(Pt. 3) Lt. Nasal cavity T3
Post RT day 1
Post RT day 22
5

• Acute and late toxicities

G grade
6
(Pt. 1) 65M Lt. Nasal cavity T1
(Pt. 2) 68M Lt. Nasal cavity T2
6Mo CR

• 5Mo CR

32Mo Local control
30Mo Local failure
7
(Pt. 3) 53M Lt. Nasal cavity T3
(Pt. 4) 56F Rt. Nasal cavity rT3

• 8Mo PR

4Mo CR
30Mo Local control
27Mo Local control
8
(Pt. 5) 73M Lt. Nasal Cavity T4
(Pt. 6) 72F Lt. Ethmoid sinus T4
3Mo CR

• 4Mo CR

5Mo Local control
12Mo Local control
9
(Pt. 7) 76F Rt. Etmoid sinus T4
(Pt. 8) 59M Lt. Hard palate T2
6Mo PR

• 3Mo CR

11Mo Local control
19Mo Local control
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Tumor response
(a) Longest diameter (mm)
(b) Area ()
Months after start of carbon RT
Months after start of carbon RT
NC no change PR partial response
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Local control and survival
(a) Local control, overall survival
(b) Disease-free survival
Months after start of carbon RT
Months after start of carbon RT
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• Treatment outcome

PTV planning target volume DOD dead of
disease AWD alive with disease
13
Conclusions

• Local effects

8 of 8 Pts reached PR within 3 months. 7 of 8 Pts
were locally controlled (median 24Mo). 2-year
local control 100
Impact on survival
6 advanced Pts developed distant metastases
within 8 months. 2 early Pts eventually developed
distant mets within 3 years. 2-year disease-free
survival 25 3-year overall survival 12.5
(1/8 Pts)
Multiple metastasis is a crucial cause of death.
Toxicities
Acute reactions tolerable and reversible. Late
reactions no severe damage was observed within
3 years.