Radioterapia în tumori cutanate:

Carcinom bazocelular
Carcinom scuamos
Melanom
Radiosensibilitatea tumorilor la
radioterapia fracţionată

melanoma
 Procentul de celule în mitoză-
carcinoame scuamoase
• carcinom scuamos al cavităţii orale:
• 23-85% (mediana 56%)

Monteiro et al. EGFR and Ki-67 expression in oral squamous cell carcinoma using tissue microarray technology. J Oral Pathol Med. 2010 Aug
1;39(7):571-8.
 Radiochirurgie (15-24 Gy într-o
singură fracţiune)
• obiectiv: necroză completă în volumul iradiat,
fără protecţia selectivă a celulelor normale
• răspuns complet la circa 60-90% 1, 2

1. Manon et al. Phase II trial of radiosurgery for one to three newly diagnosed brain metastases from renal cell carcinoma, melanoma, and
sarcoma: an Eastern Cooperative Oncology Group study (E 6397). J Clin Oncol. 2005 Dec 1;23(34):8870-6.
2. Kim et al. The usefulness of stereotactic radiosurgery for radioresistant brain metastases. J Korean Neurosurg Soc. 2013 Aug;54(2):107-
11.
 RT in non-melanoma skin cancer (basocellular
and squamous)
• All treatments have 5-yr LC of between 90-99%
for previously untreated lesions
 (Relative) contraindications for RT
• age < 50 yo (cosmetic results worsen over time)
• post-RT recurrences (suboptimal salvate with re-
irradiation )
• area prone to repeated trauma (dorsum of hand,
bony prominence, belt line)
• poor blood supply (below knees/elbows)
• high occupational sun exposure
• impaired lymphatics
• exposed bone/cartilage
• Gorlin's syndrome (aka basal cell nevus syndrome)
RT techniques
RT – kiloVoltaj-Papillon
 Adjuvant irradiation for axillary
metastases from malignant melanoma

International Journal of Radiation

Oncology*Biology*Physics
Volume 52, Issue 4, 15 March 2002
 Material and methods
• Retrospective, MDACC
• 67 males and 22 females
• 23-89 years, with a median of 54 years
• The site of the primary melanoma:
– head and neck, 3;
– trunk, 45;
– upper extremity, 16;
– unknown primary, 25
 RT dose
• 30 Gy/5 fr twice weekly (Monday and
Thursday or Tuesday and Friday) at 6 Gy per
fraction over 2.5 weeks through parallel-
opposed 6-MV photon fields
 Indication for EBRT at MDACC
• to be at high risk for subsequent axillary
recurrence (all but 2 patients)
– lymph node ≥3 cm (54 patients),
– ≥4 positive lymph nodes (44 patients),
– extracapsular extension (69 patients),
– recurrent disease after initial surgical resection
alone (23 patients),
– multiple risk factors (77 patients).
 Results/discussions
• 87% 5-year axillary control rate
– 50–70% local control achieved with surgery alone
for lymph node metastases when high-risk
features are present
• distant metastasis-free survival rates at 5 years
49%
 Roswell Park Cancer Center, 338 patients

• lymph node size increased (≥3 cm, 25% failure

rate; 3–6 cm, 42%; ≥6 cm, 80%, p<0.001)
• nodal failure after dissection alone was particularly
high in the cervical region (43%) as compared to
axillary (28%) or inguinal (23%) basins ( p=0.008).
• extracapsular extension (63% vs. 23%, p<0.0001)
• the number of involved lymph nodes (1–3 nodes,
25% failure rate; 4–10 nodes, 46%; >10 nodes,
63%).
 Burmeister et al, 1995
• 5 of the 9 nodal failures occurred outside of
the radiation field, illustrating that in-field
control is high but that full coverage of nodal
basins is required