Proton beam therapy as a nonsurgical approach to mucosal melanoma of the head and neck: a pilot study.
OBJECTIVE
The aim of this pilot study was to assess the clinical benefit of proton beam therapy for mucosal melanoma of the head and neck.


METHODS
Patients with mucosal melanoma of the head and neck with histologically confirmed malignant melanoma and N0 and M0 disease were enrolled. Proton therapy was delivered three times per week with a planned total dose of 60 Gy equivalents (GyE) in 15 fractions.


RESULTS
Fourteen consecutive patients were enrolled from January 2004 through February 2008. Patient characteristics were as follows: median age 73 years old (range, 56 to 79 years); male/female ratio, 7/7; and T stage 1/2/3/4, 3/2/0/9. All patients were able to receive the full dose of proton therapy. The most common acute toxicities were mucositis (grade 3, 21%) and mild dermatitis (grade 3, 0%). As for late toxicity, 2 patients had a unilateral decrease in visual acuity, although blindness did not occur. No treatment-related deaths occurred throughout the study. Initial local control rate was 85.7%, and, with a median follow-up period of 36.7 months, median progression-free survival was 25.1 months, and 3-year overall survival rates were 58.0%. The most frequent site of first failure was cervical lymph nodes (6 patients), followed by local failure in 1 patient and lung metastases in 1 patient. On follow-up, 5 patients died of disease, 4 died due to cachexia caused by distant metastases, and 1 patient by carotid artery perforation cause by lymph nodes metastases.


CONCLUSIONS
Proton beam radiotherapy showed promising local control benefits and would benefit from ongoing clinical study.
Division of Radiation Oncology, National Cancer Center Hospital East, Kashiwa, Chiba, Japan. szenda@east.ncc.go.jp
Sadamoto
S
Zenda
Mitsuhiko
M
Kawashima
Teiji
T
Nishio
Ryosuke
R
Kohno
Keiji
K
Nihei
Masakatsu
M
Onozawa
Satoko
S
Arahira
Takashi
T
Ogino
D000368:Aged; D002423:Cause of Death; D019583:Dose Fractionation, Radiation; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008545:Melanoma / Q000401:mortality / Q000473:pathology / Q000532:radiotherapy*; D008875:Middle Aged; D009297:Nasal Mucosa / Q000473:pathology / Q000528:radiation effects*; D009669:Nose Neoplasms / Q000401:mortality / Q000473:pathology / Q000532:radiotherapy*; D010255:Paranasal Sinus Neoplasms / Q000401:mortality / Q000473:pathology / Q000532:radiotherapy; D010865:Pilot Projects; D061766:Proton Therapy; D011522:Protons / Q000009:adverse effects; D011855:Radiodermatitis / Q000473:pathology; D011880:Radiotherapy Planning, Computer-Assisted / Q000379:methods; D012189:Retrospective Studies; D014792:Visual Acuity / Q000528:radiation effects
D011522:Protons