TY - JOUR
T1 - Sphincter-sparing local excision and adjuvant radiation for anal-rectal melanoma
AU - Ballo, Matthew T.
AU - Gershenwald, Jeffrey E.
AU - Zagars, Gunar K.
AU - Lee, Jeffrey E.
AU - Mansfield, Paul F.
AU - Strom, Eric A.
AU - Bedikian, Agop Y.
AU - Kim, Kevin B.S.
AU - Papadopoulos, Nicholas E.
AU - Prieto, Victor G.
AU - Ross, Merrick I.
PY - 2002/12/1
Y1 - 2002/12/1
N2 - Purpose: To evaluate the outcome and toxicity of a sphincter-sparing treatment strategy in the management of patients with anal-rectal melanoma. Patients and Methods: Between 1989 and 2000, 23 patients with invasive anal-rectal melanoma were managed with sphincter-sparing surgical resection and adjuvant radiation. Surgery consisted of primary local excision, as well as dissection for patients with documented regional nodal disease. Adjuvant radiation was delivered using a hypofractionated regimen of 30 Gy in five fractions over 2.5 weeks. Adjuvant systemic therapy was delivered to nine patients: cytotoxic chemotherapy in seven and immunotherapy in two. Results: After a median follow-up of 32 months, 15 patients had relapsed and 15 patients had died. The actuarial 5-year overall, disease-specific, disease-free, and distant metastasis-free survival rates were 31%, 36%, 37%, and 35%, respectively. The actuarial 5-year local and regional nodal control rates were 74% and 84%, respectively. No patient had locoregional failure as the sole site of failure and no patient required salvage abdominoperineal resection (APR). By univariate analysis, patients with nodal disease at presentation had a decreased actuarial 5-year disease-specific (0% v 45%, P = .004), disease-free (0% v 45%, P< .001), and distant metastasis-free survival (0% v42%, P < .001). The actuarial complication-free survival rate was 71%. Two patients developed mild scrotal edema (grade 1), and four patients developed moderate proctitis requiring prolonged medical management (grade 2). Conclusion: Sphincter-sparing local excision and adjuvant radiation is well tolerated and can effectively control local-regional disease while avoiding the functional morbidity of APR.
AB - Purpose: To evaluate the outcome and toxicity of a sphincter-sparing treatment strategy in the management of patients with anal-rectal melanoma. Patients and Methods: Between 1989 and 2000, 23 patients with invasive anal-rectal melanoma were managed with sphincter-sparing surgical resection and adjuvant radiation. Surgery consisted of primary local excision, as well as dissection for patients with documented regional nodal disease. Adjuvant radiation was delivered using a hypofractionated regimen of 30 Gy in five fractions over 2.5 weeks. Adjuvant systemic therapy was delivered to nine patients: cytotoxic chemotherapy in seven and immunotherapy in two. Results: After a median follow-up of 32 months, 15 patients had relapsed and 15 patients had died. The actuarial 5-year overall, disease-specific, disease-free, and distant metastasis-free survival rates were 31%, 36%, 37%, and 35%, respectively. The actuarial 5-year local and regional nodal control rates were 74% and 84%, respectively. No patient had locoregional failure as the sole site of failure and no patient required salvage abdominoperineal resection (APR). By univariate analysis, patients with nodal disease at presentation had a decreased actuarial 5-year disease-specific (0% v 45%, P = .004), disease-free (0% v 45%, P< .001), and distant metastasis-free survival (0% v42%, P < .001). The actuarial complication-free survival rate was 71%. Two patients developed mild scrotal edema (grade 1), and four patients developed moderate proctitis requiring prolonged medical management (grade 2). Conclusion: Sphincter-sparing local excision and adjuvant radiation is well tolerated and can effectively control local-regional disease while avoiding the functional morbidity of APR.
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U2 - 10.1200/JCO.2002.03.002
DO - 10.1200/JCO.2002.03.002
M3 - Article
C2 - 12454112
AN - SCOPUS:0036896396
SN - 0732-183X
VL - 20
SP - 4555
EP - 4558
JO - Journal of Clinical Oncology
JF - Journal of Clinical Oncology
IS - 23
ER -