文章：

辅助放射治疗在促结缔组织增生性黑色素瘤中的应用：一项范围综述

Adjuvant Radiation Therapy in Desmoplastic Melanoma: A Scoping Review

原文发布日期：19 November 2024

DOI: 10.3390/cancers16223874

类型: Article

开放获取: 是

英文摘要：

Desmoplastic melanoma (DM) is an uncommon subtype of cutaneous melanoma that presents distinct diagnostic and treatment challenges. This review aims to explore the role of adjuvant radiation therapy (RT) in managing DM. To evaluate this question, we reviewed relevant published reports on DM and its treatment and synthesized these findings. It was found that the clinical behavior of DM varies significantly based on its classification as either “pure” DM (pDM, ≥90% desmoplastic features) or mixed DM (mDM, ≤90% desmoplastic features). Patients with pDM have a uniquely high risk of local recurrence but a relatively lower likelihood of nodal disease. Recent studies question the necessity of sentinel lymph node biopsy for pDM patients while illustrating impressive response rates to immune checkpoint inhibition. Most data supporting adjuvant RT predate these changes in surgical management and systemic therapy, yet consistently demonstrate that adjuvant RT reduces the absolute risk of local recurrence by >50%, without significant long-term toxicity. Thus, the existing literature continues to support the conclusion that adjuvant RT effectively reduces the likelihood of local recurrence in pDM patients. Although evolving surgical and systemic therapies are reshaping treatment approaches, adjuvant RT should remain a standard of care.

摘要翻译： 

促结缔组织增生性黑色素瘤（DM）是一种罕见的皮肤黑色素瘤亚型，其诊断与治疗面临独特挑战。本文旨在探讨辅助放射治疗（RT）在DM治疗中的作用。为评估该问题，我们系统回顾了已发表的DM相关研究及治疗报告，并对现有证据进行综合分析。研究发现，DM的临床行为因其分类为“纯”促结缔组织增生性黑色素瘤（pDM，促结缔组织增生特征≥90%）或混合型促结缔组织增生性黑色素瘤（mDM，促结缔组织增生特征≤90%）而存在显著差异。pDM患者具有极高的局部复发风险，但淋巴结转移概率相对较低。近期研究对pDM患者前哨淋巴结活检的必要性提出质疑，同时显示免疫检查点抑制剂治疗具有显著应答率。支持辅助RT的多数数据虽早于当前手术及全身治疗的变革，但一致表明辅助RT可使局部复发的绝对风险降低50%以上，且无显著长期毒性。因此，现有文献仍支持辅助RT能有效降低pDM患者局部复发风险的结论。尽管不断演进的手术与全身治疗正在重塑治疗策略，辅助RT仍应作为标准治疗方案予以保留。

原文链接：

Adjuvant Radiation Therapy in Desmoplastic Melanoma: A Scoping Review