title: Treatment of regional cutaneous nodular metastases from melanoma using high-dose rate mould brachytherapy.
abstract: BACKGROUND
  The involvement of a wide body surface area by regional cutaneous nodular metastases (RCNM) from melanoma poses a significant therapeutic challenge. We report our experience from Waikato Hospital, Hamilton, New Zealand in successfully treating this condition with high-dose rate (HDR) surface mould brachytherapy (BT).
  
  
  METHODS
  We analysed six patients who had surgery and then developed RCNM, which was treated in our department by HDR mould BT using Iridium 192. Five out of six patients were treated with a dose of 30 Gy in five fractions to wide field with a further 6 Gy boost to tumour nodules. Our first patient received a higher dose of 36 Gy in six fractions followed by 6 Gy boost to tumour nodules.
  
  
  RESULTS
  All patients experienced a complete response (CR). Median follow up was 23 months and side effects were minimal, only Radiation Therapy Oncology Group (RTOG) grade I/II early and late toxicity. To date, no in-field recurrence has been observed. Two patients died from metastatic disease at 33 and 34 months of follow up.
  
  
  CONCLUSIONS
  There was a CR in all cases without in-field recurrence. To our knowledge, this is the first reported experience in treating skin melanoma with a BT surface mould. We recommend that BT surface mould should be considered when treating patients with RCNM.
authors.affiliation: Department of Radiation Oncology, Regional Cancer Centre, Waikato Hospital, Hamilton, New Zealand. chaudhurianupam@hotmail.com
authors.forename: Anupam
authors.initials: A
authors.lastname: Chaudhuri
authors.forename: Charles
authors.initials: C
authors.lastname: De-Groot
authors.forename: Matthew
authors.initials: M
authors.lastname: Seel
authors.forename: Mike
authors.initials: M
authors.lastname: Jolly
authors.forename: Tina
authors.initials: T
authors.lastname: Cameron
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001918:Brachytherapy / Q000379:methods*; D005260:Female; D006801:Humans; D007496:Iridium Radioisotopes / Q000627:therapeutic use*; D008207:Lymphatic Metastasis / Q000532:radiotherapy*; D008297:Male; D008545:Melanoma / Q000532:radiotherapy* / Q000556:secondary; D008875:Middle Aged; D009367:Neoplasm Staging; D011879:Radiotherapy Dosage; D012878:Skin Neoplasms / Q000473:pathology* / Q000532:radiotherapy*; D016896:Treatment Outcome
chemical_list: D007496:Iridium Radioisotopes