We reported two cases of malignant melanoma with multiple metastases who were satisfactorily treated with electron irradiation in reducing pain of bone metastases or improving disabling nervous symptoms respectively.
Case 1: A 40-year-old woman who had underwent wide local excision of a pigment macule on the left sole following three courses of chemotherapy (DAV) under the diagnosis of multiple metastases of malignant melanoma was referred to us in September, 1993. On admission, she received combination chemotherapy with ranimustine, vincristine and peplomycin which failed to prevent the metastases. For the reduction of the pain and prevention of fracture of bone metastases, electron irradiation in combination with local microwave hyperthermia was performed. The schedule was 6 Gy a time, twice a week to the total of 36 Gy on each irradiation site. Although the patient died of brain metastases in February, 1995, the effect on the pain was remarkable. Oral morphine HCl could be reduced and withdrawn during irradiation.
Case 2: A 67-year-old man was admitted for his primary melanoma nodule on the left sole and lymph node metastases on the left groin in December, 1993. After wide local excision and lymph node dissection, he was treated with systemic chemotherapy (5 courses of DAV) and local IFN-β injection on secondary skin metastases without satisfactory effect. Cisplatin was also ineffective for hemiplegia, hemianopia and agnosia which developed in July, 1994. Whole and local brain electron irradiation of total 37.8 Gy improved hemiplegia and hemianopia. Metastatic image on brain CT was reduced. Irradiation was obliged to stop for leukopenia and the patient died in February, 1995.
Although radiotherapy is not the first choice for malignant melanoma, especially multiple metastases so far, even low LET beam, such as electron beam, is thought to be useful clinically from our experiences.
