A case of cervical melanoma was treated with palliative aim because of large volume macroscopic disease, while three cases of vaginal melanoma were irradiated with a total dose of 68.8 Gy (relative biological effectiveness) in 16 fractions delivered over 4 weeks (4 days a week). completed the scheduled treatment course. During CIRT, toxicity was mild. For patients with vaginal disease, local control was 10.23 and 12.6 months, while that for cervical malignant melanoma was 7.3 months. All patients experienced systemic progression, with median distant metastasis-free survival of 11.7 months. The median overall survival for the whole patient group was 11.41 months. Conclusion: In our first experiences, CIRT appears to be a safe non-invasive option for malignant melanoma of the lower genital tract, but more data and longer follow-up are necessary in order to evaluate the effectiveness and late effects. (14) and Molinelli (15). The CE-marked Syngo RT Planning treatment planning system (Siemens AG Healthcare, Erlangen, Germany), version C13, was used for plan optimization and calculation of relative biological effectiveness (RBE)-weighted dose distributions according to the Local Effect Model (LEM) pirinixic acid (WY 14643) version I, with the following parameters: =0.1 Gy?1, =0.05 Gy?2, Dt=30 Gy, nuclear radius=5 m (16). Intensity-modulated particle therapy was employed as plan optimization strategy (17,18). Once approved, each plan was checked by a medical physicist according to our institutional protocol for patient-specific pre-treatment dosimetric verification (19). Patient set-up was verified at VAV2 each treatment session by means of two independent custom verification systems, namely an infrared optical tracking system and a stereoscopic x-ray verification device (20). Six-degrees of freedom set-up correction vector was calculated and remotely applied to the treatment table. As regards vaginal MMM, the clinical target volume (CTV) 1 was defined as the inguinal lymph nodes and the small pelvis (internal iliac, external iliac, obturator lymph nodes) including the GTV with a minimum margin of 5 mm, which was irradiated with 38.7 Gy RBE in nine fractions. CTV2, was equal to the GTV with a minimum margin of 5 mm and was irradiated up to a total dose of 68.8 Gy RBE in 16 fractions (Figure 1). Limiting dose for organ at risks was 60 Gy RBE for the rectum. Open in a separate window Figure 1 A case of vaginal melanoma treated with carbon ion radiotherapy. The clinical target volume (CTV) 1 (orange line) was irradiated with up to a total dose of 38.7 Gy relative biological effectiveness (RBE) in nine fractions, followed by a boost of up to a total dose of 68.8 Gy RBE to CTV2 (fuchsia line). The patient with pirinixic acid (WY 14643) cervical MMM was treated with a palliative dose of 24 Gy RBE in three fractions and, because of the large volume of macroscopic disease, the CTV was defined as the uterine cervix and corpus. Toxicity was scored according to Common Terminology Criteria for Adverse Events version pirinixic acid (WY 14643) 4.0 (21). Time to event data were calculated from the end of CIRT. Results Patient and tumor characteristics are described in Table I. The median age of women was 60.5 (range=49-72) years and the Karnofsky Performance Status was 90. All patients were wild-type for V-Raf pirinixic acid (WY 14643) murine sarcoma viral oncogene homolog B1 ( em BRAF /em )/neuroblastoma RAS viral oncogene homolog ( em NRAS pirinixic acid (WY 14643) /em ), and tyrosine kinase C ( em c-KIT /em ) mutation was identified in one vaginal MMM. No neoadjuvant or concomitant chemotherapy was administered. Table I Patient, tumor and treatment characteristics. Open in a separate window BRAF: V-Raf murine sarcoma viral oncogene homolog B1; NRAS: neuroblastoma RAS viral oncogene homolog; c-KIT: tyrosine kinase C; MMM: malignant mucosal melanoma; GTV: gross tumor volume; RBE: relative biological effectiveness. aSee Figure 1. Patients with vaginal MMM had no nodal metastases and the maximum tumor extension observed by imaging/ gynecological bimanual evaluation was 37 mm, 12 mm and 5 mm, respectively, corresponding to GTV of 28.01 cc, 25.59 cc and 1.2 cc. The cervical MMM invaded the bladder and rectum, showed an extension of 8090100 mm and a GTV of.