Effective palliative radiotherapy in primary malignant melanoma of the esophagus: a case report
© licensee BioMed Central Ltd. 2009
Received: 27 March 2009
Accepted: 3 August 2009
Published: 19 August 2009
Primary malignant melanoma of the esophagus is a rare but highly aggressive tumor with poor prognosis. Surgical resection is the treatment of choice. However, some cases may be diagnosed with advanced inoperable disease. Palliative radiotherapy may be used to relieve symptoms caused by the esophageal tumor.
We report on a case of advanced inoperable primary malignant melanoma of the esophagus treated with palliative radiotherapy. The patient's dysphagia resolved with radiotherapy.
Malignant melanoma of the esophagus is rare. Patients with advanced inoperable malignant melanomas of the esophagus benefit from radiation therapy. Radiation therapy is effective for palliation.
Primary malignant melanoma of the esophagus is an uncommon disease accounting for only 0.1 % to 0.5 % of all esophageal carcinomas -. It has a highly aggressive tumor behavior with a median survival of about 10 months . Some patients are inoperable at presentation. Radiation therapy has been used to relieve symptoms. Malignant melanomas are generally considered radioresistant, requiring higher dose per fraction. We report on a case of primary malignant melanoma of the esophagus treated with palliative radiotherapy.
Primary malignant melanoma affecting the esophagus is a rare and fatal disease with a poor prognosis. Sabanathan et al. documented that approximately 50% of patients have metastatic disease at presentation and long-term survival is extremely rare . The clinical presentation of primary malignant melanoma of the esophagus is similar to the common forms of primary esophageal malignancies. The tumor most commonly occurs in the 6th and 7th decade, and the male to female ratio is 2:1. Subtotal esophagectomy is recommended as the treatment of first choice for primary malignant melanoma of the esophagus. Sabanathan et al. reported a median survival of between 7 and 12 months in patients who underwent radical resection and a 5 year survival of 4.2 % . Chalkiadakis et al. reported, in a series of 110 patients, a mean survival of 13 months . However, at the time of diagnosis, some cases may be diagnosed as having inoperable carcinoma. Chemotherapy is one of the treatment options for malignant melanoma. However, it is difficult to use chemotherapy to elderly or poor performance status patients. Paul et al. reported that the response rate for dacarbazine alone was 16.9 % and was 21.5% for dacarbazine plus immunotherapy . Although radiotherapy may have a palliative role if surgery is not possible, malignant melanoma has been considered radioresistant . At the time of diagnosis of the present case, multiple lymph node metastases were observed and the performance status was 3. Therefore, radical surgery and chemotherapy were not considered. There have been several case reports of effective palliation with photon radiotherapy [11, 12]. Forgarty et al. reported that a patient with malignant melanoma of the esophagus received 36 Gy with a photon beam in six fractions given twice weekly, and CT after 4 months following completion of radiotherapy showed no residual mass . In the present case, palliative radiotherapy using a once-daily fractionation of 3.0 Gy was offered, and the tumor markedly decreased in size and partial response was achieved.
Malignant melanoma of the esophagus is rare. Patients with advanced inoperable melanomas of the esophagus benefit from radiation therapy. Radiation therapy is effective for palliation.
Written informed consent was obtained from the daughter of the patient for publication of this case report and accompanying images. A copy of the written consent is available for review by the Editor-in-Chief of this journal.
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