Role of radiotherapy in patients with head and neck mucosal melanoma - a literature review.

Primary surgery, with an attempt to remove a tumor within the margin of healthy tissues, is the treatment of choice in head and neck mucosal melanoma (HNMM). Unfortunately, radical procedures are frequently difficult, mainly due to the anatomical conditions in the operated region associated with close proximity of numerous critical structures with important functions. It must be underlined that HNMM is characterized by particularly frequent local recurrences. The analysis of the literature shows that a vast majority of authors prove in a relatively unambiguous way that the usage of postoperative radiotherapy (PRT) reduces the occurrence of locoregional recurrences compared with surgery alone. Unfortunately, PRT does not affect remote survival outcomes, which is mainly associated with the tendency of HNMM to disseminate early and massively. Commonly acknowledged criteria for PRT include failure to obtain macro- or microscopic radicality of surgery. Other indications, as suggested by certain authors, encompass patients in whom the procedure was radical with a relatively small microscopic margin. Currently preferred total dose of radiation is 60-70 Gy administered in the period of 6-7 weeks according to a conventional fractionation system, i.e. 1.8-2.0 Gy delivered once daily. Primary radiation therapy is used in patients with advanced neoplasm or those who are not eligible for surgery due to poor performance status; this group also includes patients who do not consent to surgical treatment. Primary radiotherapy gives a chance not only for a good palliative effect, but also, in certain patients, for complete local control. The condition is the application of, for example, intensity-modulated radiotherapy (IMRT) and administration of an adequately high dose of biological radiation, usually using hypofractionation. The fact that proton beam therapy or irradiation with carbon ions gives hope for a marked improvement in local curability in this group of patients is incontestable. [ABSTRACT FROM AUTHOR]