Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, USA.
Cancer. 2011 Oct 15;117(20):4747-55. doi: 10.1002/cncr.26088. Epub 2011 Mar 28.
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.
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.
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.
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.
肛门直肠黑色素瘤是一种预后不良的罕见疾病。由于生存取决于远处转移的失败，许多中心采用保留括约肌的切除术来控制原发性肿瘤。然而，这种方法与较高的局部失败率（约 50%）相关。在这项研究中，作者报告了他们 20 年来采用保留括约肌的切除术联合放射治疗（RT）治疗局限性肛门直肠黑色素瘤的经验。
作者回顾了 1989 年至 2008 年期间在德克萨斯大学 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病历。所有患者均接受了确定性局部切除手术，部分患者行前哨淋巴结活检或淋巴结清扫术。39 例患者接受了扩展野 RT（25-36 格雷，分 5-6 次给予），以靶向原发部位和引流盆腔/腹股沟淋巴结；15 例患者接受了仅靶向原发部位的局限野 RT。
5 年局部控制率（LC）、淋巴结控制率（NC）和括约肌保留率分别为 82%、88%和 96%。然而，由于远处转移率较高，5 年总生存率（OS）仅为 30%。尽管根据 RT 野范围，LC、NC 或 OS 无显著差异，但接受扩展野 RT 的患者比接受局限野 RT 的患者发生淋巴水肿的风险更高。
目前的结果表明，联合保留括约肌的局部切除和 RT 是一种可耐受的方法，可为肛门直肠黑色素瘤患者提供有效的 LC。将腹股沟淋巴结区纳入 RT 野并未改善预后，反而增加了淋巴水肿的风险。
