TY - JOUR
T1 - Sphincter-sparing local excision and hypofractionated radiation therapy for anorectal melanoma
T2 - A 20-year experience
AU - Kelly, Patrick
AU - Zagars, Gunar K.
AU - Cormier, Jancie N.
AU - Ross, Merrick I.
AU - Guadagnolo, B. Ashleigh
PY - 2011/10/15
Y1 - 2011/10/15
N2 - BACKGROUND: Anorectal melanoma is a rare disease with a poor prognosis. Because survival is determined by distant failure, many centers have adopted sphincter-sparing excision for primary tumor control. However, this approach is associated with high rates of local failure (∼50%). In this study, the authors report their 20-year experience with sphincter-sparing excision combined with radiation therapy (RT) for the treatment of localized anorectal melanoma. METHODS: The authors reviewed the records of 54 patients with localized anorectal melanoma who were treated at the University of Texas MD Anderson Cancer Center from 1989 to 2008. All patients underwent definitive local excision with or without sentinel lymph node biopsy or lymph node dissection. RT (25-36 grays in 5-6 fractions) was delivered to extended fields that targeted the primary site and draining pelvic/inguinal lymphatics in 39 patients and to limited fields that targeted only the primary site in 15 patients. RESULTS: The 5-year rates of local control (LC), lymph node control (NC), and sphincter preservation were 82%, 88%, and 96%, respectively. However, because of the high rate of distant metastasis, the overall survival (OS) rate at 5 years was only 30%. Although there were no significant differences in LC, NC, or OS based on RT field extent, patients who received extended-field RT had higher rates of lymphedema than patients who received limited-field RT. CONCLUSIONS: The current results indicated that combined sphincter-sparing local excision and RT is a well tolerated approach that provides effective LC for patients with anorectal melanoma. Inclusion of the inguinal lymph node basins in the RT fields did not improve outcomes and was associated with an increased risk of lymphedema. Cancer 2011;. © 2011 American Cancer Society. The authors report their 20-year experience with sphincter-sparing excision combined with radiation therapy for the treatment of localized anorectal melanoma. The results indicated that sphincter-sparing local excision with adjuvant radiation therapy is a well-tolerated approach that provides effective local control for these patients.
AB - BACKGROUND: Anorectal melanoma is a rare disease with a poor prognosis. Because survival is determined by distant failure, many centers have adopted sphincter-sparing excision for primary tumor control. However, this approach is associated with high rates of local failure (∼50%). In this study, the authors report their 20-year experience with sphincter-sparing excision combined with radiation therapy (RT) for the treatment of localized anorectal melanoma. METHODS: The authors reviewed the records of 54 patients with localized anorectal melanoma who were treated at the University of Texas MD Anderson Cancer Center from 1989 to 2008. All patients underwent definitive local excision with or without sentinel lymph node biopsy or lymph node dissection. RT (25-36 grays in 5-6 fractions) was delivered to extended fields that targeted the primary site and draining pelvic/inguinal lymphatics in 39 patients and to limited fields that targeted only the primary site in 15 patients. RESULTS: The 5-year rates of local control (LC), lymph node control (NC), and sphincter preservation were 82%, 88%, and 96%, respectively. However, because of the high rate of distant metastasis, the overall survival (OS) rate at 5 years was only 30%. Although there were no significant differences in LC, NC, or OS based on RT field extent, patients who received extended-field RT had higher rates of lymphedema than patients who received limited-field RT. CONCLUSIONS: The current results indicated that combined sphincter-sparing local excision and RT is a well tolerated approach that provides effective LC for patients with anorectal melanoma. Inclusion of the inguinal lymph node basins in the RT fields did not improve outcomes and was associated with an increased risk of lymphedema. Cancer 2011;. © 2011 American Cancer Society. The authors report their 20-year experience with sphincter-sparing excision combined with radiation therapy for the treatment of localized anorectal melanoma. The results indicated that sphincter-sparing local excision with adjuvant radiation therapy is a well-tolerated approach that provides effective local control for these patients.
KW - anorectal melanoma
KW - radiation complications
KW - radiation therapy
KW - sphincter preservation
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U2 - 10.1002/cncr.26088
DO - 10.1002/cncr.26088
M3 - Article
C2 - 21446049
AN - SCOPUS:80053926026
SN - 0008-543X
VL - 117
SP - 4747
EP - 4755
JO - Cancer
JF - Cancer
IS - 20
ER -