Value of radiation therapy for distant metastases from malignant melanoma

these articles discuss in detail the treatment of the primary melanoma and of regional lymph node metastases but make only the following references to the management of distant metastases. Vogler, Perdue, and Wilkins28 state that “. . . occasionally distant metastasis, particularly to bone, will respond quite gratifyingly . . .” to radiation therapy. Poppp3 states that in cases of metastatic malignant melanoma that appear hopeless, intensive radiotherapy may occasionally produce quite satisfactory palliative results. Windeyel.32 believes that ‘ I . , . [radiation] therapy should be used. . . as a particularly useful palliative in more advanced lesions.” According to McNeer,l7 “Some temporary regression and palliation are occasionally observed.. .” after radiation therapy. Ackerman and del Regatol write: “In advanced malignant melanoma the clinical course is usually swift with increasing dissemination of the tumor and death. In a small percentage of cases unpredictable events occur. Some cases show unexpected radiosensitivity but are seldom radiocurable. We have seen a patient survive over 5 years with metastases in the liver.” With systemic chemotherapy, encouraging results have been reported only by Coggins, Ravdin, and Eisman,6 who using cyclophosphamide (Cytoxan) claimed “good response” in 3 of 8 cases. Others report, however, only occasional response or none at all. Weeth and SegaloPO using AB-100 obtained subjective improvement without regression in only 2 of 11 cases and objective improvement in only 1 of 11. H$st and Nissen-Meyerl3 using cyclophosphamide had a moderate response in only 1 of 8 patients. Moore and Watnelg state that