TY - JOUR
T1 - Outcomes After Sphincter-Sparing Local Therapy for Anorectal Melanoma
T2 - 1989 to 2020
AU - Mitra, Devarati
AU - Rao, Pallavi Krishna
AU - Nagarajan, Priyadharsini
AU - Bishop, Andrew J.
AU - Farooqi, Ahsan S.
AU - Gershenwald, Jeffrey E.
AU - Wargo, Jennifer
AU - Keung, Emily Z.
AU - Fisher, Sarah B.
AU - Amaria, Rodabe N.
AU - Davies, Michael A.
AU - Ross, Merrick I.
AU - Guadagnolo, B. Ashleigh
N1 - Funding Information:
Sources of support: This work was supported by Cancer Center Support (Core) Grant CA016672 to (PI-Pisters) The University of Texas MD Anderson Cancer Center. Disclosures: Dr Amaria has received grants or contracts from Merck, Novartis, BMS, and Iovance Biotherapeutics as well as honoraria from BMS and Iovance Biotherapeutics. She also participates in the DSMB or advisory board of Novartis, BMS and Iovance Biotherapeutics. Dr Davies has received consulting fees from Roche, Pfizer, Novartis, BMS < Vaccinex, Apexigen, and ABM Therapeutics. He also has a collaboration with Nanostring.
Funding Information:
Sources of support: This work was supported by Cancer Center Support (Core) Grant CA016672 to (PI-Pisters) The University of Texas MD Anderson Cancer Center.
Publisher Copyright:
© 2022 American Society for Radiation Oncology
PY - 2022/9/1
Y1 - 2022/9/1
N2 - Purpose: The treatment paradigm for patients with anorectal melanoma eligible for sphincter-sparing excision has evolved over time. This study examines outcomes across a 30-year era in this rare disease with poor prognosis. Methods and Materials: This retrospective cohort study included all patients with pelvis-confined anorectal melanoma undergoing sphincter-sparing local excision and adjuvant radiation therapy (RT) at our institution between 1989 and 2020. Patterns of care and predictors of outcome were evaluated. Results: Of the 108 patients included, 92 (85%) presented with clinically uninvolved nodes. For clinically node-negative patients, the sentinel lymph node biopsy rate increased from 18/43 (42%) before 2008 to 38/49 (78%) subsequently and the use of inguinal nodal RT decreased from 33/35 (94%) before 2003 to 1/57 (2%) subsequently. All clinically node-positive patients treated before 2003 received inguinal nodal RT, whereas no node-positive patient treated subsequently received this treatment. Patients treated before 2016 mostly received biochemotherapy, and those treated since 2017 mostly received immune checkpoint inhibitors. With median follow-up of 32 months, 77 patients (71%) recurred. Three-year actuarial outcomes were 84% local control, 64% nodal control, 38% distant metastasis-free survival, 30% disease-free survival, and 51% melanoma-specific survival. Ostomy-free survival at last follow-up was 95%. Factors contributing to outcome were identified. Outcomes for patients treated in the contemporary era (2017+) were not significantly better than those treated earlier. Conclusions: Sphincter-sparing surgery followed by adjuvant RT results in excellent local control and ostomy-free survival for locally resectable anorectal melanoma. Overall oncologic outcomes continue to be poor, reinforcing the need to identify more effective therapies.
AB - Purpose: The treatment paradigm for patients with anorectal melanoma eligible for sphincter-sparing excision has evolved over time. This study examines outcomes across a 30-year era in this rare disease with poor prognosis. Methods and Materials: This retrospective cohort study included all patients with pelvis-confined anorectal melanoma undergoing sphincter-sparing local excision and adjuvant radiation therapy (RT) at our institution between 1989 and 2020. Patterns of care and predictors of outcome were evaluated. Results: Of the 108 patients included, 92 (85%) presented with clinically uninvolved nodes. For clinically node-negative patients, the sentinel lymph node biopsy rate increased from 18/43 (42%) before 2008 to 38/49 (78%) subsequently and the use of inguinal nodal RT decreased from 33/35 (94%) before 2003 to 1/57 (2%) subsequently. All clinically node-positive patients treated before 2003 received inguinal nodal RT, whereas no node-positive patient treated subsequently received this treatment. Patients treated before 2016 mostly received biochemotherapy, and those treated since 2017 mostly received immune checkpoint inhibitors. With median follow-up of 32 months, 77 patients (71%) recurred. Three-year actuarial outcomes were 84% local control, 64% nodal control, 38% distant metastasis-free survival, 30% disease-free survival, and 51% melanoma-specific survival. Ostomy-free survival at last follow-up was 95%. Factors contributing to outcome were identified. Outcomes for patients treated in the contemporary era (2017+) were not significantly better than those treated earlier. Conclusions: Sphincter-sparing surgery followed by adjuvant RT results in excellent local control and ostomy-free survival for locally resectable anorectal melanoma. Overall oncologic outcomes continue to be poor, reinforcing the need to identify more effective therapies.
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U2 - 10.1016/j.prro.2022.02.012
DO - 10.1016/j.prro.2022.02.012
M3 - Article
C2 - 35278716
AN - SCOPUS:85130502947
SN - 1879-8500
VL - 12
SP - 437
EP - 445
JO - Practical radiation oncology
JF - Practical radiation oncology
IS - 5
ER -