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Objective To evaluate the clinical efficacy,failure pattern and prognostic factors of the malignant mucosal melanoma of the head and neck ( MMHN) in a single center. Methods The treatment pattern,clinical efficacy, failure pattern and prognostic factors of 194 M0MMHN patients admitted to our institution from 1982 to 2017 were retrospectively analyzed.Results The 5-year overall survival (OS),local recurrence-free survival ( LRFS ), regional recurrence-free survival ( RRFS ) and distant metastasis-free survival (DMFS) were 41. 4%,57. 8%,76. 5% and 46. 5%,respectively. The failure rate was calculated as 74. 6%(141/189).Among them,40% (56/141) had distant metastasis as the first pattern of treatment failure,37%(52/141) had local relapse,15%(21/141) had regional relapse,5%(7/141) had concurrent distant metastasis and local/regional relapse and 3% ( 5/141) had concurrent local and regional relapse. Multivariate analysis demonstrated that surgical margins (P=0. 001) and adjuvant radiotherapy (P=0. 000) were the independent prognostic factors for LRFS. Conclusions Surgery combined with radiotherapy can yield relatively high LRFS in the comprehensive treatment of MMHN.Distant metastasis is the major failure pattern.
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Objective To investigate the treatment outcome of primary mucosal melanoma of the nasal cavity and paranasal sinuses and the role of radiotherapy in the treatment of this disease .Methods The clinical data of 52 patients with primary mucosal melanoma of the nasal cavity and paranasal sinuses who were admitted to our hospital from 2001 to 2014 were analyzed retrospectively.Among these patients, 18 received surgery alone, 31 received surgery combined with radiotherapy ( 24 received surgery and postoperative radiotherapy and 7 received preoperative radiotherapy and surgery ) , and 3 received radiotherapy alone.The surgery+radiotherapy group and the surgery group were matched using propensity score matching.Results The median follow-up was 59 months.The 5-year local control ( LC), distant metastasis-free survival (DMFS), disease-free survival (DFS), and overall survival (OS) of all patients were 49%, 48%, 22%, and 45%, respectively.After matching, the surgery+radiotherapy group had a significantly higher LC than the surgery group (88%vs.43%, P=0.028), but the two groups had similar 5-year DMFS (67%vs.57%, P=0.955), 5-year DFS (58%vs.24%, P=0.131), and 5-year OS (67%vs. 67%, P=0.727 ) .The negative margin rates in the preoperative radiotherapy+surgery subgroup and the surgery+postoperative radiotherapy subgroup were 100%and 50%, respectively ( P=0.004) .Conclusions Surgery combined with radiotherapy can improve the LC rate in patients with primary mucosal melanoma of the nasal cavity and paranasal sinuses, and preoperative radiotherapy can increase the negative margin rate.
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Objective To investigate the clinical features and survival status of mucosal melanoma of the nasal cavity and paranasal sinuses and to analyze the prognostic factors.Methods A retrospective analysis was performed on the clinical data of 94 patients with mucosal melanoma of the nasal cavity and paranasal sinuses treated from January 2000 to December 2012.Of the 94 patients,50 were male,and 44 were female.The median age of onset was 60 years (range,26-85 years).The primary sites were nasal cavity (86 patients),maxillary sinus (7 patients),and nasopharynx (1 patient).Cervical lymph node metastasis was observed in 10 patients (7 patients before treatment,2 patients during treatment,and 1 patient after treatment).No patient had distant metastasis.Patients were treated with surgery ± radiotherapy.The Kaplan-Meier method was used to calculate survival rates,and the logrank test was used for univariate prognostic analysis;the Cox regression model was used for multivariate prognostic analysis.Results The 1-,3-,and 5-year sample sizes were 80,54,and 50,respectively.The 1-,3-,and 5-year disease-related survival rates were 71％,33％,and 22％,respectively.Univariate analysis showed that the prognostic factors were age over 55 years (P =0.034),involvement of the posterior naris (P =0.011),involvement of the maxillary sinus (P =0.009),involvement of the hard palate (P =0.003),cervical lymph node metastasis (P =0.001),and therapeutic method (P =0.038).Multivariate analysis showed that the prognostic factors were involvement of the posterior naris (P =0.027),involvement of the orbit (P =0.005),and involvement of the hard palate (P =0.003).Conclusions The distant metastasis and local recurrence rates are high among patients with mucosal melanoma of the nasal cavity and paranasal sinuses,so combination therapy is imperative.Cervical lymph node metastasis rate is low.Rational clinical staging needs to be further explored.
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Objective To evaluate the toxicity and efficacy of carbon ion radiotherapy for cutaneous malignant melanoma. Methods Form December 2006 to May 2009, 13 patients with superficial malignant melanoma were treated with carbon ion radiotherapy in the Institute of Modern Physics, Chinese Academy of Sciences. The total dose was 60 -66 GyE in 6 -12 fractions within 6 -12 days. The disease was Stage Ⅱ_a in 2, Ⅱ_b in 3, Ⅱ_c in 5, and Ⅲ_c in 3 patients. The toxicities were assessed according to the Radiation Therapy Oncology Group (RTOG) criteria, and the efficacy was evaluated with WHO criteria. Results The median follow-up time was 13.5 months (range, 1 -25 months) and the follow-up rate was 100%. Of the 13 patients, 10(77%) achieved complete remission (CR), and 3(23%) partial remission (PR). The overall response rate (RR) was 100%, and the median survival time was 21.3 months (95% CI, 18. 1 -24.5 months). The grade 0, 1,2 and 3 skin reaction occurred in 3, 6, 2 and 2 patients, respectively. The hematologic toxicities were mild. Conclusions Carbon ion radiotherapy is a safe and effective treatment for cutaneous malignant melanoma.
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Objective To evaluate the therapeutic effects of treatments of eye-retaining and enucleation for choroidal melanomas. Methods The clinical data of 44 patients (44 eyes) with choroidal melanomas after eye-retaining treatments and enucleation surgery were retrospectively analyzed. The metastasis, retention rate of eyeball after eye-retaining treatment, and visual acuity prognosis were observed and analyzed. In 44 eyes treated by eye-retaining therapy, transpupillary thermotherapy (TTT) was performed primaryly on 7 (15.9%),~ 106 Ru brachytherapy on 25 (56.8%), and local resection of tumor combined with ~ 106 Ru brachytherapy on 12 (27.3%).The average follow-up period was 13.3 months. Results Forty-four patients had no melanoma metastasis during the follow-up period. In 39 patients (88.6%) who had their eyes retained successfully, the retention rate of eyeball was 100%, 92.9%, and 83.3% in 6, 14, and 24 eyes with small, middle, and large tumor, respectively. In the patients treated by eye-retaining therapy, the visual acuity was ≥0.3 in 11 (28.2%), ≥0.05-