Results of Combination Therapy in 13 Patients with Sinonasal and Upper Jaw Malignant Melanoma
Akiyoshi KonnoYuuji UekiYuusuke MadaRyousuke Uchida
Southern Tohoku General Hospital Japan
摘要：5 year disease-free survival rates（DFS） of sinonasal melanoma treated either by surgery,conventional radiation,or combination of both are very poor ranging 2040%.Recent development of radiation using proton beam（PB） or stereotactic radiation using the Cyberknife in patients with sinonasal melanoma has shown promising results.In this 11 years we have treated 13 patients with MO sinonasal and upper jaw melanoma by planned combination of surgery,pre or postoperative radiation and chemotherapy using DAV（DTIC,ACNU,VCR）.Median age was 68.5（4786） and TNM classification（UICC,2009） was T3 N0/T3 N1/T4 N0/T4 N1:3/1/7/3.In all patients en bloc resection was performed,together with total or partial neck dissection,followed by primary reconstruction in 11 patients.Preoperative radiation was chosen in 5 patients in whom preoperative reduction of tumor was considered desirable for preservation of QOL using PB,70.4 GyE,32 fr in 3 and the Cyberknife,30 GyE,6 fr in 2 patients.Postoperative radiation was chosen in 8 patients in whom en bloc resection with primary reconstruction was considered feasible without causing marked deterioration of QOL using PB,70.4 GyE,32 fr in 2 and intensity-modulated radiation therapy（IMRT）,66 Gy,33 fr in 6 patients.A retrospective analysis of clinicopathological data from 2004 to 2015 was performed.Median follow-up was 60±14（16-146） months.5 year DFS were 81.1%.2 patients with maxillary sinus melanoma,T4 aNlM0 and T4 aN0 M0,died of distant metastasis in one year.No local recurrence was observed during follow-up period.Histopathological effects of preoperative radiotherapy using proton beam in 3 and the Cyberknife in 2 were grade 3（no survival cells） in 1,grade 2 b（minimal viable cells） in 2 and grade 2 a in 2 patients.In selected patients who show rapidly progressive disease process early combination of immunotherapy using anti PD-1 monoclonal antibody may be warranted to prevent distant metastasis.
BIT’s 10th Annual World Cancer Congress-2017