NEW YORK (Reuters Health) Apr 29 - A sphincter-sparing local excision plus hypofractionated radiation therapy is well tolerated and effective for patients with rare anorectal melanomas, according to doctors who recently reported on 2 decades of using this approach.
The "vast majority" of patients with anorectal melanoma die of distant metastasis within 2 to 3 years of diagnosis - but in the authors' series of 54 patients, nearly two-thirds were alive at 2 years and a third were still alive at 5 years, according to a March 28th online report in Cancer.
Lead author Dr. Patrick Kelly and colleagues from The University of Texas MD Anderson Cancer Center in Houston had previously reported initial success with their combination of sphincter-sparing wide local excision plus adjuvant hypofractionated radiation therapy for localized anorectal melanoma. In this report, they update their 20-year experience with this approach in 54 patients.
"It is our clinical practice to recommend adjuvant radiation therapy after patients undergo negative-margin surgical resection of a primary anorectal melanoma," the researchers say.
By the time of final analysis, 39 patients (72%) had relapsed and 42 (78%) had died, with a median overall survival of 29 months.
The actuarial disease-specific survival rates were 60% at 2 years and 32% at 5 years, and the actuarial overall survival rates were 59% at 2 years and 30% at 5 years.
On multivariate analysis, the only factor that significantly predicted worse disease-specific survival and overall survival was lymph node involvement, which was also the only significant predictor of distant metastasis.
The local disease control rate was 85% at 2 years and 82% at 5 years. Only two patients required a permanent colostomy.
Although the actuarial rate of lymph node relapse was 12% at 2 years, no patient experienced an isolated lymph node relapse. All lymph node relapses occurred in association with local recurrence or distant relapse.
Treatment was generally well tolerated, and surgical complications were uncommon. Nearly half the patients (26 patients, 48%) had late complications associated with radiation therapy (16 mild, 9 moderate, 1 severe).
"Because the outcome for patients with anorectal melanoma is determined by distant disease recurrence, further progress in the care of these patients likely will come from improved systemic therapies that address the risk of distant disease," the investigators conclude.
The "vast majority" of patients with anorectal melanoma die of distant metastasis within 2 to 3 years of diagnosis - but in the authors' series of 54 patients, nearly two-thirds were alive at 2 years and a third were still alive at 5 years, according to a March 28th online report in Cancer.
Lead author Dr. Patrick Kelly and colleagues from The University of Texas MD Anderson Cancer Center in Houston had previously reported initial success with their combination of sphincter-sparing wide local excision plus adjuvant hypofractionated radiation therapy for localized anorectal melanoma. In this report, they update their 20-year experience with this approach in 54 patients.
"It is our clinical practice to recommend adjuvant radiation therapy after patients undergo negative-margin surgical resection of a primary anorectal melanoma," the researchers say.
By the time of final analysis, 39 patients (72%) had relapsed and 42 (78%) had died, with a median overall survival of 29 months.
The actuarial disease-specific survival rates were 60% at 2 years and 32% at 5 years, and the actuarial overall survival rates were 59% at 2 years and 30% at 5 years.
On multivariate analysis, the only factor that significantly predicted worse disease-specific survival and overall survival was lymph node involvement, which was also the only significant predictor of distant metastasis.
The local disease control rate was 85% at 2 years and 82% at 5 years. Only two patients required a permanent colostomy.
Although the actuarial rate of lymph node relapse was 12% at 2 years, no patient experienced an isolated lymph node relapse. All lymph node relapses occurred in association with local recurrence or distant relapse.
Treatment was generally well tolerated, and surgical complications were uncommon. Nearly half the patients (26 patients, 48%) had late complications associated with radiation therapy (16 mild, 9 moderate, 1 severe).
"Because the outcome for patients with anorectal melanoma is determined by distant disease recurrence, further progress in the care of these patients likely will come from improved systemic therapies that address the risk of distant disease," the investigators conclude.
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