title: Sphincter-sparing local excision and hypofractionated radiation therapy for anorectal melanoma: a 20-year experience.
abstract: 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.
authors: Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, USA.
authors: Patrick
authors: P
authors: Kelly
authors: Gunar K
authors: GK
authors: Zagars
authors: Jancie N
authors: JN
authors: Cormier
authors: Merrick I
authors: MI
authors: Ross
authors: B Ashleigh
authors: BA
authors: Guadagnolo
mesh_terms: D000328:Adult; D000368:Aged; D001003:Anal Canal; D001005:Anus Neoplasms / Q000532:radiotherapy / Q000601:surgery / Q000628:therapy*; D019583:Dose Fractionation, Radiation; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D053208:Kaplan-Meier Estimate; D008197:Lymph Node Excision; D008198:Lymph Nodes / Q000473:pathology / Q000601:surgery; D008207:Lymphatic Metastasis; D008297:Male; D008545:Melanoma / Q000532:radiotherapy / Q000601:surgery / Q000628:therapy*; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000175:diagnosis / Q000628:therapy; D059351:Organ Sparing Treatments / Q000379:methods*; D018714:Radiotherapy, Adjuvant; D012004:Rectal Neoplasms / Q000532:radiotherapy / Q000601:surgery / Q000628:therapy*; D012189:Retrospective Studies; D012878:Skin Neoplasms / Q000532:radiotherapy / Q000601:surgery / Q000628:therapy*; D016896:Treatment Outcome