Sphincter-Sparing Local Excision and Hypofractionated Radiation Therapy for Anorectal Melanoma A 20-Year Experience
Sphincter-Sparing Local Excision and Hypofractionated Radiation Therapy for Anorectal Melanoma A 20-Year Experience
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DOI：
10.1002/cncr.26088
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发表时间：
2011-10-15
期刊：
影响因子：
6.2
通讯作者：
Guadagnolo, B. Ashleigh
中科院分区：
文献类型：
--
作者：
Kelly, Patrick;Zagars, Gunar K.;Guadagnolo, B. Ashleigh
背景：肛门直肠黑色素瘤是一种罕见的疾病，预后差。由于生存率取决于远端失败，许多中心采用保留括约肌的切除术来控制原发肿瘤。然而，这种方法与高局部失败率（类似于50%）相关。在这项研究中，作者报告了他们20年的经验，保留括约肌切除联合放射治疗（RT）治疗局限性肛门直肠黑色素瘤。方法：作者回顾了1989年至2008年在德克萨斯大学MD安德森癌症中心接受治疗的54例局限性肛门直肠黑色素瘤患者的记录。所有患者均接受了明确的局部切除术，伴或不伴前哨淋巴结活检或淋巴结清扫。RT（25-36格雷，5-6次）被输送到39例患者的靶向原发部位和引流盆腔/腹股沟淋巴管的扩展射野，以及15例患者的仅靶向原发部位的有限射野。结果：局部控制（LC）、淋巴结控制（NC）和括约肌保留的5年率分别为82%、88%和96%。然而，由于远处转移率高，5年总生存率（OS）仅为30%。虽然有没有显着差异，LC，NC，或OS的基础上RT领域的程度，患者接受扩大领域RT有更高的发病率比患者接受有限领域RT。结论：目前的结果表明，联合保肛局部切除和RT是一种耐受性良好的方法，为肛门直肠黑色素瘤患者提供有效的LC。将腹股沟淋巴结盆纳入RT视野并未改善结局，且与水肿风险增加相关。Cancer 2011;117：4747-55. (C)2011年美国癌症协会
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 (similar to 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;117:4747-55. (C) 2011 American Cancer Society.