Malignant melanoma of the vagina and locoregional control: radical surgery revisited.
Malignant melanoma of the vagina and locoregional control: radical surgery revisited.
复制标题
阴道恶性黑色素瘤和局部控制：重新审视根治性手术。
DOI：
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发表时间：
1998
影响因子：
4.7
通讯作者：
Willie A. Andersen
中科院分区：
文献类型：
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作者：
W. Irvin;Susan A. Bliss;Laurel W. Rice;Peyton T. Taylor;Willie A. Andersen
背景
轶事报告和回顾性病例回顾表明，阴道黑色素瘤的主要治疗方法是根治性手术切除，可改善局部控制，并可能改善总生存率。本研究旨在通过病例介绍和文献回顾，重新评估根治性盆腔手术在阴道黑色素瘤治疗中的作用。
情况
从1966年到1996年，在弗吉尼亚大学医院发现了7例原发性阴道黑色素瘤，并对每例进行了初步治疗、无病期、复发部位和总生存率的比较。所有死于疾病的患者在死亡前局部复发，但两名接受广泛局部切除（WLE）后接受术后高剂量分割远距离治疗的患者除外。
结论
在阴道黑色素瘤的初级治疗中使用WLE后进行高剂量分次远距离治疗似乎提供了良好的局部控制，而没有伴随的发病率和与更根治性手术切除相关的身体缺陷。本文报道的结果以及其他已发表的报告表明，即使是大的黑色素瘤，当以高个体分数（大于400 cGy/fx）给药时，放疗也可以获得局部控制。这种类型的反应是一致的较高的反应率与皮肤黑色素瘤时，大的个人馏分相比，传统的分割。由于阴道黑色素瘤的生存率极低，无论主要治疗，新的治疗策略，包括进一步研究使用高剂量分割照射，是迫切需要的。
BACKGROUND
Anecdotal reports and retrospective case reviews suggest improved locoregional control, and possibly overall survival, with radical surgical extirpation as the primary management of vaginal melanoma. This study seeks to reevaluate, through case presentation and literature review, the usefulness of radical pelvic surgical procedures in the management of vaginal melanoma.
CASE
Seven cases of primary vaginal melanoma were seen at the University of Virginia Hospital from 1966 to 1996; each was compared in terms of primary management, disease-free interval, sites of relapse, and overall survival. All patients who died of their disease relapsed locally prior to their death, with the exception of two patients who underwent wide local excision (WLE) followed by postoperative high-dose fractionation teletherapy.
CONCLUSIONS
The use of WLE followed by high-dose fractionation teletherapy in the primary management of vaginal melanoma appears to provide excellent locoregional control, without the attendant morbidity and physical disfigurement associated with more radical surgical resection. The results reported here, as well as other published reports, suggest that locoregional control may be obtained with even large melanomas with radiotherapy when administered in high individual fractions (greater than 400 cGy/fx). This type of response is consistent with the higher response rate seen with cutaneous melanomas when large individual fractions are compared to conventional fractionation. Because of the extremely poor survival with vaginal melanoma regardless of primary therapy, novel therapeutic strategies, including further investigation into the use of high-dose fractionation irradiation, are urgently needed.