Curative carbon ion radiotherapy in a head and neck mucosal melanoma series: Facing the future within multidisciplinarity

Sara Ronchi; Alessandro Cicchetti; Maria Bonora; Rossana Ingargiola; Anna Maria Camarda; Stefania Russo; Sara Imparato; Paolo Castelnuovo; Ernesto Pasquini; Piero Nicolai; Mohssen Ansarin; Michele Del Vecchio; Marco Benazzo; Ester Orlandi; Barbara Vischioni

doi:10.1016/j.radonc.2023.110003

Curative carbon ion radiotherapy in a head and neck mucosal melanoma series: Facing the future within multidisciplinarity

Radiother Oncol. 2024 Jan:190:110003. doi: 10.1016/j.radonc.2023.110003. Epub 2023 Nov 11.

Authors

Affiliations

¹ Radiation Oncology Unit, Clinical Department, National Center for Oncological Hadrontherapy (CNAO), Pavia, Italy. Electronic address: sara.ronchi@cnao.it.
² Prostate Cancer Program, Fondazione IRCCS Istituto Nazionale dei Tumori, Via Giacomo Venezian, 1, 20133 Milano, Italy.
³ Radiation Oncology Unit, Clinical Department, National Center for Oncological Hadrontherapy (CNAO), Pavia, Italy.
⁴ Medical Physics Unit, Clinical Department, National Center for Oncological Hadrontherapy (CNAO), Pavia, Italy.
⁵ Radiology Unit, Clinical Department, National Center for Oncological Hadrontherapy (CNAO), Pavia, Italy.
⁶ Department of Otorhinolaryngology, Department of Biotechnology and Life Sciences, University of Insubria, Varese, Italy; Head and Neck Surgery & Forensic Dissection Research Center (HNS&FDRc), Department of Biotechnology and Life Sciences, University of Insubria, Varese, Italy.
⁷ Azienda USL di Bologna, ENT Department, Bellaria Hospital, Bologna, Italy.
⁸ Section of Otorhinolaryngology - Head and Neck Surgery, Department of Neurosciences, University of Padua - "Azienda Ospedaliera di Padova", Padua, Italy.
⁹ Division of Otolaryngology and Head and Neck Surgery, IEO, European Institute of Oncology IRCCS, Milan, Italy.
¹⁰ Unit of Melanoma Medical Oncology, Department of Medical Oncology and Hematology, Fondazione IRCCS Istituto Nazionale dei Tumori, Via Giacomo Venezian 1, Milan 20133, Italy.
¹¹ Department of Otolaryngology Head Neck Surgery, University of Pavia, IRCCS Policlinico San Matteo Foundation, Pavia, Italy.

PMID: 37956889
DOI: 10.1016/j.radonc.2023.110003

Abstract

Purpose: To evaluate efficacy and toxicity of carbon ion radiotherapy (CIRT) in locally advanced head and neck mucosal melanoma (HNMM) patients treated at our Institute.

Materials and methods: Between June 2013 and June 2020, 40 HNMM patients were treated with CIRT. Prescription dose was 65.6-68.8 Gy relative biological effectiveness [RBE] in 16 fractions. Twelve (30%) patients received only biopsy, 28 (70%) surgical resection before CIRT. Immunotherapy was administered before and/or after CIRT in 45% of patients, mainly for distant progression (89%).

Results: Median follow-up was 18 months. 2-year Local Relapse Free Survival (LRFS), Overall Survival (OS), Progression Free Survival (PFS) and Distant Metastasis Free Survival (DMFS) were 84.5%, 58.6%, 33.2% and 37.3%, respectively. At univariate analysis, LRFS was significantly better for non-recurrent status, < 2 surgeries before CIRT and treatment started < 9 months from the initial diagnosis, with no significant differences for operated versus unresected patients. After relapse, immunotherapy provided longer median OS (17 months vs 3.6, p-value<0.001). Late toxicity ≥ G3 (graded with CTCAE 5.0 scale) was reported in 10% of patients.

Conclusion: CIRT in advanced HNMM patients is safe and locally effective. Prospective trials are warranted to assess the role of targeted/immune- systemic therapy to improve OS.

Keywords: Carbon Ion Radiotherapy; Combined Modality Therapy; Head and Neck Cancer; Immunotherapy; Mucosal Melanoma; Multidisciplinary Care Team.

MeSH terms

Head and Neck Neoplasms* / etiology
Head and Neck Neoplasms* / radiotherapy
Heavy Ion Radiotherapy* / adverse effects
Humans
Melanoma* / pathology
Melanoma* / radiotherapy
Neoplasm Recurrence, Local / pathology
Prospective Studies