title: Fast neutron radiotherapy for primary mucosal melanomas of the head and neck.
abstract: BACKGROUND
  Primary head and neck mucosal melanomas (HNMMs) are rare tumors managed with surgery and/or radiotherapy and associated with poor outcomes. Given their radioresistance, high linear energy transfer radiotherapy with neutrons may improve local control.
  
  
  METHODS
  We conducted a retrospective review of 14 patients with HNMM treated with neutrons at the University of Washington from 1990 to 2012. Five patients had T3 disease, 9 had T4 disease, 3 had regional nodal disease, and 4 had distant metastases at diagnosis. Primary sites were sinonasal (n=10), lip (n=2), and palate (n=2). Ten patients had initial surgical resection/debulking.
  
  
  RESULTS
  Nine patients had gross residual disease, 6 had complete response, and 3 had partial response. Local control was achieved in 79% until death or last follow-up, and 50% developed distant metastases. Kaplan-Meier 5-year local control was 66% and overall survival was 21%.
  
  
  CONCLUSIONS
  High rates of locoregional control were achieved with neutrons, despite the presence of gross disease. Survival was limited by early distant metastases.
authors.affiliation: University of Washington, Department of Radiation Oncology, Seattle, Washington.
authors.forename: Jay J
authors.initials: JJ
authors.lastname: Liao
authors.forename: Upendra
authors.initials: U
authors.lastname: Parvathaneni
authors.forename: George E
authors.initials: GE
authors.lastname: Laramore
authors.forename: John A
authors.initials: JA
authors.lastname: Thompson
authors.forename: Shailender
authors.initials: S
authors.lastname: Bhatia
authors.forename: Neal D
authors.initials: ND
authors.lastname: Futran
authors.forename: Amit D
authors.initials: AD
authors.lastname: Bhrany
authors.forename: Stephen E
authors.initials: SE
authors.lastname: Hawes
authors.forename: Matthew
authors.initials: M
authors.lastname: Ladra
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005214:Fast Neutrons / Q000009:adverse effects / Q000627:therapeutic use*; D005260:Female; D006258:Head and Neck Neoplasms / Q000473:pathology / Q000532:radiotherapy*; D006801:Humans; D008297:Male; D008545:Melanoma / Q000473:pathology / Q000532:radiotherapy*; D008875:Middle Aged; D009092:Mucous Membrane / Q000473:pathology*; D012189:Retrospective Studies; D016019:Survival Analysis; D016896:Treatment Outcome
keywords: fast neutrons; head and neck neoplasms; mucosal melanoma; radiotherapy; sinonasal