Sphincter-sparing local excision and adjuvant radiation for anal-rectal melanoma

Matthew Ballo, Jeffrey E. Gershenwald, Gunar K. Zagars, Jeffrey E. Lee, Paul F. Mansfield, Eric A. Strom, Agop Y. Bedikian, Kevin B.S. Kim, Nicholas E. Papadopoulos, Victor G. Prieto, Merrick I. Ross

Research output: Contribution to journalArticle

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Abstract

Purpose: To evaluate the outcome and toxicity of a sphincter-sparing treatment strategy in the management of patients with anal-rectal melanoma. Patients and 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% v42%, 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). Conclusion: Sphincter-sparing local excision and adjuvant radiation is well tolerated and can effectively control local-regional disease while avoiding the functional morbidity of APR.

Original languageEnglish (US)
Pages (from-to)4555-4558
Number of pages4
JournalJournal of Clinical Oncology
Volume20
Issue number23
DOIs
StatePublished - Dec 1 2002
Externally publishedYes

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Melanoma
Radiation
Survival Rate
Neoplasm Metastasis
Proctitis
Immunotherapy
Dissection
Edema
Morbidity
Drug Therapy
Survival
Therapeutics

All Science Journal Classification (ASJC) codes

  • Oncology
  • Cancer Research

Cite this

Ballo, M., Gershenwald, J. E., Zagars, G. K., Lee, J. E., Mansfield, P. F., Strom, E. A., ... Ross, M. I. (2002). Sphincter-sparing local excision and adjuvant radiation for anal-rectal melanoma. Journal of Clinical Oncology, 20(23), 4555-4558. https://doi.org/10.1200/JCO.2002.03.002

Sphincter-sparing local excision and adjuvant radiation for anal-rectal melanoma. / Ballo, Matthew; Gershenwald, Jeffrey E.; Zagars, Gunar K.; Lee, Jeffrey E.; Mansfield, Paul F.; Strom, Eric A.; Bedikian, Agop Y.; Kim, Kevin B.S.; Papadopoulos, Nicholas E.; Prieto, Victor G.; Ross, Merrick I.

In: Journal of Clinical Oncology, Vol. 20, No. 23, 01.12.2002, p. 4555-4558.

Research output: Contribution to journalArticle

Ballo, M, Gershenwald, JE, Zagars, GK, Lee, JE, Mansfield, PF, Strom, EA, Bedikian, AY, Kim, KBS, Papadopoulos, NE, Prieto, VG & Ross, MI 2002, 'Sphincter-sparing local excision and adjuvant radiation for anal-rectal melanoma', Journal of Clinical Oncology, vol. 20, no. 23, pp. 4555-4558. https://doi.org/10.1200/JCO.2002.03.002
Ballo, Matthew ; Gershenwald, Jeffrey E. ; Zagars, Gunar K. ; Lee, Jeffrey E. ; Mansfield, Paul F. ; Strom, Eric A. ; Bedikian, Agop Y. ; Kim, Kevin B.S. ; Papadopoulos, Nicholas E. ; Prieto, Victor G. ; Ross, Merrick I. / Sphincter-sparing local excision and adjuvant radiation for anal-rectal melanoma. In: Journal of Clinical Oncology. 2002 ; Vol. 20, No. 23. pp. 4555-4558.
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abstract = "Purpose: To evaluate the outcome and toxicity of a sphincter-sparing treatment strategy in the management of patients with anal-rectal melanoma. Patients and 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{\%} v42{\%}, 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). Conclusion: Sphincter-sparing local excision and adjuvant radiation is well tolerated and can effectively control local-regional disease while avoiding the functional morbidity of APR.",
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AU - Ballo, Matthew

AU - Gershenwald, Jeffrey E.

AU - Zagars, Gunar K.

AU - Lee, Jeffrey E.

AU - Mansfield, Paul F.

AU - Strom, Eric A.

AU - Bedikian, Agop Y.

AU - Kim, Kevin B.S.

AU - Papadopoulos, Nicholas E.

AU - Prieto, Victor G.

AU - Ross, Merrick I.

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Y1 - 2002/12/1

N2 - Purpose: To evaluate the outcome and toxicity of a sphincter-sparing treatment strategy in the management of patients with anal-rectal melanoma. Patients and 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% v42%, 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). Conclusion: Sphincter-sparing local excision and adjuvant radiation is well tolerated and can effectively control local-regional disease while avoiding the functional morbidity of APR.

AB - Purpose: To evaluate the outcome and toxicity of a sphincter-sparing treatment strategy in the management of patients with anal-rectal melanoma. Patients and 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% v42%, 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). Conclusion: Sphincter-sparing local excision and adjuvant radiation is well tolerated and can effectively control local-regional disease while avoiding the functional morbidity of APR.

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