Melanoma is a skin neoplasm that originates from malignant transformation of melanocytes.
It commonly occurs in the extremities of women and on trunk or head and neck in men.
Metastases are via lymphatic and hematogenous routes.
Used as definitive therapy in patients with unresectable stage III melanoma with clinical satellite or in-transit disease, or in patients ineligible for surgery
Management option for patients with lentigo maligna who are not in favor of surgical therapy
May be considered in primary disease desmoplastic melanoma with narrow margins, comorbidities or extensive neurotropism and in regional disease as adjuvant therapy in patients with lentigo maligna melanoma whose surgical margins were inadequate, in patients with microscopic tumor remnants, or bulky disease post-surgery and as palliative therapy for unresectable satellite, nodal or in-transit melanoma
Recommended regimens for definitive radiotherapy:
Primary disease: 64-70 Gy in 32-35 fractions for 6-7 weeks; 50-57.5 Gy in 20-23 fractions for 4-5 weeks; 35 Gy in 5 fractions for 1 week; 32 Gy in 4 fractions once/week
Regional disease: 24-27 Gy in 3 fractions for 1-1.5 weeks; 32 Gy in 4 fractions, 40 Gy in 8 fractions or 50 Gy in 20 fractions for 4 weeks; 30 Gy in 5 or 10 fractions for 2 weeks; 20 Gy in 5 fractions for 1 week; 8 Gy in 1 fraction for 1 day
Distant metastases: Depends on the technique, tumor size and whether as primary or adjuvant therapy
Preferred radiotherapy techniques to be used for brain metastases, both as primary and adjuvant therapy, include stereotactic radiosurgery (SRS), fractionated stereotactic radiation therapy (SRT) and image-guided radiation therapy (IGRT) is recommended for better accuracy in the delivery
Whole brain radiation therapy (WBRT) as primary treatment may be considered in patients with numerous brain lesions and with symptoms due to intracranial pressure
Adjuvant WBRT may be used in cases of suspected leptomeningeal spread or when SRT and SRS are not technically feasible
For extracranial metastases, stereotactic body radiation therapy (SBRT) may be considered
Adjuvant nodal basin radiotherapy for stage III with clinically positive nodes and unresectable stage IV melanoma with brain metastases may be delivered via intensity-modulated or image-guided techniques
Recommended regimens for adjuvant radiotherapy:
Primary disease: 60-66 Gy in 30-33 fractions in 6-7 weeks; 48 Gy in 20 fractions for 4 weeks; 30 Gy in 5 fractions for 2 weeks
Regional disease: 50-66 Gy in 25-33 fractions for 5-7 weeks; 48 Gy in 20 fractions for 4 weeks; 30 Gy in 5 fractions for 2 weeks
Every-two-month injections of the long-acting cabotegravir + rilpivirine were noninferior to once-monthly injections for virologic suppression at 48 weeks in people living with HIV*, according to the ATLAS-2M** study presented at CROI 2020 — thus providing a potential option with more convenient dosing.
Sustained use of lopinavir-combined regimen appears to confer benefits among patients with the novel coronavirus disease (COVID-19), with improvement possibly indicated by increasing eosinophils, suggests a recent study.
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