Short-Course Radiotherapy

Adjuvant radiotherapy has retrospective evidence for improved local control in head-and-neck mucosal melanoma. SCRT was selected instead of CRT for practical advantages including shorter duration, lower cost, fewer staffing needs, and a shorter acute toxicity period. Hypofractionated radiotherapy is considered potentially more effective than prolonged conventional fractionation for melanoma. The protocol selects 25 Gy in five fractions as the short-course radiotherapy schedule. Treatment is delivered in three fractions on alternate days over one week, starting at 8 Gy per fraction (24 Gy total), escalating to a maximum of 11 Gy per fraction (33 Gy total). All treatment arms begin with SCRT at 25 Gy delivered in five daily 5 Gy fractions. For cN1 patients, the protocol does not add elective lateral lymph node irradiation. Radiotherapy may potentiate antitumour immunity through immunogenic cell death, damage-associated molecular patterns, MHC class I expression, and cGAS-STING activation. The protocol avoids high-dose neurosurgical radiosurgery because subablative doses may be sufficient for functional ganglion modification rather than destruction. Short-course hypofractionated radi…