M. Foote1, P. Guitera2,3,4, T. Wang3,5, E. Paton3,6, N. Williams3,6, G.B. Fogarty2,6,7,8
Aims: The role of radiation therapy (RT) is changing in melanoma due to advances in treatment. Australia and New Zealand Melanoma Trials Group (ANZMTG) evaluates the role and safety of RT in different scenarios with well-designed multicentre internationally recruiting randomised controlled trials (RCT) providing evidence in conjunction with Trans-Tasman Radiation Oncology Group (TROG).
Methods: ANZMTG has facilitated investigators to create and conduct several RCTs evaluating the role of RT in controversial areas of melanoma management over the past 15 years, covering primary to metastatic disease.
Results: For primary lesions, ANZMTG 01.09 RTN2 trial is a RCT of observation versus RT following complete resection of neurotropic melanoma of head and neck, 42 of 100 accrued. ANZMTG 02.12 RADICAL trial, a RCT of Imiquimod versus RT for Lentigo Maligna, open at nine sites, 45 of 266 accrued. For regional disease, ANZMTG 01.02 Adjuvant Radiotherapy Nodal trial, published 2014 showed significant reduction in nodal failure with RT versus observation in high risk stage 3. For metastatic disease, ANZMTG 01.07 WBRTMel investigating whole brain radiotherapy following local treatment for patients with up to three brain metastases has completed accrual, 215 participants. ANZMTG 02.14 Combi RT is a phase 2 RT dose escalation study for combination BRAF MEK inhibitor therapy. Trials in development look at combining RT with immunotherapy in melanoma.
Conclusion: High quality RCTs are establishing the role of RT in melanoma. Melanoma centres should ensure ongoing engagement of radiation oncologists in multidisciplinary meetings so patients can access effective evidence based treatments.