Sphincter-sparing local excision and adjuvant radiation for anal-rectal melanoma.
OBJECTIVE
To evaluate the outcome and toxicity of a sphincter-sparing treatment strategy in the management of patients with anal-rectal melanoma.


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% v 42%, 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).


CONCLUSIONS
Sphincter-sparing local excision and adjuvant radiation is well tolerated and can effectively control local-regional disease while avoiding the functional morbidity of APR.
Ballo
Matthew T
MT
Department of Radiation Oncology, University of Texas M.D. Anderson Cancer Center, Houston 77030, USA. mballo@mdanderson.org
Gershenwald
Jeffrey E
JE
Zagars
Gunar K
GK
Lee
Jeffrey E
JE
Mansfield
Paul F
PF
Strom
Eric A
EA
Bedikian
Agop Y
AY
Kim
Kevin B S
KB
Papadopoulos
Nicholas E
NE
Prieto
Victor G
VG
Ross
Merrick I
MI
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001005:Anus Neoplasms / Q000473:pathology / Q000532:radiotherapy* / Q000601:surgery*; D019583:Dose Fractionation, Radiation; D005260:Female; D006801:Humans; D008207:Lymphatic Metastasis; D008297:Male; D008545:Melanoma / Q000532:radiotherapy* / Q000556:secondary / Q000601:surgery*; D008875:Middle Aged; D009361:Neoplasm Invasiveness; D018714:Radiotherapy, Adjuvant; D012004:Rectal Neoplasms / Q000473:pathology / Q000532:radiotherapy* / Q000601:surgery*; D012720:Severity of Illness Index; D016019:Survival Analysis; D016896:Treatment Outcome