Ongoing high quality randomised trials are helping define the role of Radiotherapy in melanoma — ASN Events
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Ongoing high quality randomised trials are helping define the role of Radiotherapy in melanoma (#33)

Gerald Fogarty 1 2 3 4 , Angela Hong 3 5 6 , Matthew Foote 7 , Kari Dolven Jacobsen 8 , Claudius Reisse 8 , Pascale Guitera 3 6 , Tim Wang 3 , Mark R Middleton 9 10 , Elizabeth Paton 4 , Bryan Burmeister 4 7
  1. Department of Radiation Oncology, St Vincent's and Mater Hospitals, Sydney, NSW, Australia
  2. University of New South Wales, Sydney, NSW, Australia
  3. Melanoma Institute Australia, Sydney, NSW, Australia
  4. Australia and New Zealand Melanoma Trials Group (ANZMTG), Sydney, NSW, Australia
  5. Sydney Medical School, The University of Sydney, Sydney, NSW, Australia
  6. Sydney Cancer Centre, Royal Prince Alfred Hospital, Sydney, NSW, Australia
  7. Princess Alexandra Hospital, Brisbane, QLD, Australia
  8. Oslo University Hospital - The Radium Hospital, Oslo, Norway
  9. Department of Oncology, University of Oxford, Oxford, UK
  10. Churchill Hospital, Oxford, UK

Aims
The general opinion in the melanoma community is that melanoma is radio-resistant. However this opinion is not evidence based. The Australia and New Zealand Melanoma Trials Group (ANZMTG) is evaluating the role of radiotherapy (RT) in different scenarios with well-designed multicentre internationally recruiting randomised controlled trials (RCT) to provide evidence in conjunction with the Trans-Tasman Radiation Oncology Group (TROG), and the Oncology Clinical Trials Office (OCTO; Oxford UK).

Methods
ANZMTG has facilitated investigators to create 5 RCTs evaluating the role of RT in controversial areas of melanoma management in the past 12 years. These are in different stages of evolution and cover primary to metastatic disease.

Results
For primary lesions, ANZMTG 02.09 / TROG 08.09 RTN2 trial is a RCT of observation versus RT following complete resection of neurotropic Melanoma of head and neck and has 31 of 100 accrued. ANZMTG 02.12 RADICAL trial, a RCT of Imiquimod versus RT for Lentigo Maligna, is newly approved by ethics and commencing accrual imminently. For regional disease, ANZMTG 01.02 Adjuvant Radiotherapy Nodal trial, published last year, showed significant reduction in nodal failure from 32% to 18% with 48Gy in 20 fractions versus observation following lymphadenectomy for high risk stage 3 disease. For metastatic disease, ANZMTG 01.07 / TROG 08.05 WBRTMel investigates the role of whole brain radiotherapy following local treatment for patients with up to three brain metastases. This has accrued 172 of a planned 200 patients in six years. ANZMTG 02.14 Combi RT is a phase 2 radiation therapy dose escalation study for patients on combination BRAF MEK inhibitor therapy.

Conclusion
There are high quality RCTs, completed or in progress, that are establishing the role of radiotherapy in Melanoma. Melanoma centres in the future may need to ensure radiation oncologists are engaged in their multidisciplinary meetings so patients can access effective evidence based treatments.

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