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Annals of Surgical Oncology

, Volume 21, Issue 11, pp 3401–3405 | Cite as

Outcomes of Merkel Cell Carcinoma Treated with Radiotherapy without Radical Surgical Excision

  • Chris Harrington
  • Winkle Kwan
Melanomas

Abstract

Background

Achieving clear surgical margins in Merkel cell carcinoma (MCC) can be difficult due to tumor location or patient comorbidity. Clinical impression suggests that radiation treatment achieves good control of macroscopic disease.

Methods

A retrospective chart review was undertaken of all patients with pathological evidence of MCC and treated with curative intent at the BC Cancer Agency between 1979 and 2007. This is a report on the outcomes of those with gross disease treated with radiotherapy, without radical surgery.

Results

Fifty-seven patients received definitive radiotherapy to the primary and/or nodal disease. Median age was 75 years and median follow-up was 34 months (84.5 months for those alive at last follow-up). American Joint Committee on Cancer (AJCC) stage distribution was 23, 19, and 58 % for stages I, II, and III, respectively. Tumor control at sites treated for macroscopic disease was 88 % at 12 months and 82 % at 2 years, and 5-year local relapse-free survival (RFS) was 90 %. Five-year RFS, cancer-specific survival (CSS), and overall survival were 57, 68, and 39 %, respectively. On univariate and multivariate analyses, only male sex was associated with a worse RFS, and a radiotherapy dose >50 Gy was associated with a better CSS.

Limitations

The retrospective nature of the study and small sample size limit the strength of the conclusions.

Conclusions

Radical radiotherapy is effective in the curative treatment of MCC, especially in patients who would tolerate wide surgical excision poorly, or where it would cause significant cosmetic or functional deficits.

Keywords

Sentinel Node Biopsy Merkel Cell Carcinoma Wide Local Excision Relative Biological Effectiveness Wide Surgical Excision 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

Notes

Conflicts of Interest

None declared.

References

  1. 1.
    Poulsen M. Merkel cell carcinoma of skin: diagnosis and management strategies. Drugs Aging 2005;22(3):219-229.PubMedCrossRefGoogle Scholar
  2. 2.
    Allen PJ, Bowne WB, Jaques DP, Brennan MF, Busam K, Coit DG. Merkel cell carcinoma: prognosis and treatment of patients from a single institution. J Clin Oncol. 2005:23:2300-2309.PubMedCrossRefGoogle Scholar
  3. 3.
    Zhan FQ, Packianatha VS, Zeitouni NC. Merkel cell carcinoma: a review of current advances J Natl Compr Canc Netw. 2009;7(3):333-339.PubMedGoogle Scholar
  4. 4.
    Miller SJ, Alam M, Andersen J, Berg D, Bichakjian CK, Bowen G, et al. The NCCN Merkel cell carcinoma clinical practice guidelines in oncology. J Natl Compr Canc Netw. 2009;7:322-332.PubMedGoogle Scholar
  5. 5.
    Nghiem P, McKee PH, Haynes HA. Merkel cell (cutaneous neuroendocrine) carcinoma. In: Sober AJ, Haluska FG, editors. Skin cancer. Hamilton (ON): BC Decker Inc., 2001, pp 127-141.Google Scholar
  6. 6.
    Calder KB, Smoller BR. New insights into Merkel cell carcinoma. Adv Anat Pathol. 2010;17(3):155-161.PubMedCrossRefGoogle Scholar
  7. 7.
    Ghadjar P, Kaanders JH, Poortmans P, Zaucha R, Krengli M, Lagrange JL, et al. The essential role of radiotherapy in the treatment of Merkel cell carcinoma: a study from the rare cancer network. Int J Radiat Oncol Biol. Phys. 2011;81(4):e583-591.PubMedCrossRefGoogle Scholar
  8. 8.
    Meeuwissen JA, Bourne G, Kezarsley H. The importance of postoperative radiation therapy in the treatment of Merkel cell carcinoma. Int J Radiat Oncol Biol Phys. 1995;31(2):325-331.PubMedCrossRefGoogle Scholar
  9. 9.
    Edge SB, Byrd DR, Compton CC, et al., editors. Merkel cell carcinoma. In: AJCC cancer staging manual. 7th ed. New York (NY): Springer, 2010, pp 315–23.Google Scholar
  10. 10.
    Eng TY, Boersma MG, Fuller CD, Goytia V, Jones WE, Joyner M, et al. A comprehensive review of the treatment of Merkel cell carcinoma. Am J Clin Oncol. 2007;30:624-636.PubMedCrossRefGoogle Scholar
  11. 11.
    Ascoli V, Minelli G, Kanieff M, Frova L, Conti S. Merkel cell carcinoma: a population-based study on mortality and the association with other cancers. Cancer Causes Control. 2011;22:1521-1527.PubMedCrossRefPubMedCentralGoogle Scholar
  12. 12.
    Elliott E . Trabecular cell carcinoma: report of a case. Ann Plast Surg. 1981;7(2):163-164.PubMedCrossRefGoogle Scholar
  13. 13.
    Pacella J, Ashby M, Ainslie J, Minty C. The role of radiotherapy in the management of primary cutaneous neuroendocrine tumors (Merkel cell or trabecular carcinoma): experience at the Peter MacCallum Cancer Institute (Melbourne, Australia). Int J Radiat Oncol Biol Phys. 1988:14(6):1077-84.PubMedCrossRefGoogle Scholar
  14. 14.
    Pilotti S, Rilke F, Bartoli C, Grisotti A. Clinicopathologic correlations of cutaneous neuroendocrine Merkel cell carcinoma. J Clin Oncol. 1988;6(12):1863-1873.PubMedGoogle Scholar
  15. 15.
    Ashby MA, Jones DH, Tasker AD, Blackshaw AJ. Primary cutaneous neuroendocrine (Merkel cell or trabecular carcinoma) tumour of the skin: a radioresponsive tumour. Clin Radiol. 1989;40(1):85-7.PubMedCrossRefGoogle Scholar
  16. 16.
    Morrison WH, Peters LJ, Silva EG, Wendt CD, Ang KK, Goepfert H. The essential role of radiation therapy in securing locoregional control of Merkel cell carcinoma. Int J Radiation Oncol Biol Phys. 1990:19(3):583-591.CrossRefGoogle Scholar
  17. 17.
    Hasle H. Merkel cell carcinoma: the role of primary treatment with radiotherapy. Clin Oncol (R Coll Radiol). 1991;3(2):114-116.PubMedCrossRefGoogle Scholar
  18. 18.
    Suntharalingam M, Rudoltz MS, Mendenhall WM, et al. Radiotherapy for Merkel cell carcinoma of the skin of the head and neck. Head Neck. 1995;17(2):96-101.PubMedCrossRefGoogle Scholar
  19. 19.
    Poulsen M, Rischin D, Walpole E, Harvey J, Mackintosh J, Ainslie J, et al. High-risk Merkel cell carcinoma of the skin treated with synchronous carboplatin/etoposide and radiation: a Trans-Tasman Radiation Oncology Group Study—TROG 96:07. J Clin Oncol. 2003;21(23):4371-4376.PubMedCrossRefGoogle Scholar
  20. 20.
    Mortier L, Mirabel X, Fournier C, Piette F, Lartigau E. Radiotherapy alone for primary Merkel cell carcinoma. Arch Dermatol. 2003;139(12):1587-1590.PubMedCrossRefGoogle Scholar
  21. 21.
    Koh CSL, Veness MJ. Role of definitive radiotherapy in treating patients with inoperable Merkel cell carcinoma: the Westmead Hospital experience and a review of the literature. Australas J Dermatol. 2009;50(4):249-256.PubMedCrossRefGoogle Scholar
  22. 22.
    Fang LC, Lemos B, Douglas J, Iyer J, Nghiem P. Radiation monotherapy as regional treatment for lymph node-positive Merkel cell carcinoma. Cancer. 2010;116(7):1783-90.PubMedCrossRefGoogle Scholar
  23. 23.
    Foote M, Harvey J, Porceddu S, Dickie G, Hewitt S, Colquist S, et al. Effect of radiotherapy dose and volume on relapse in Merkel cell cancer of the skin. Int J Radiat Oncol Biol Phys. 2010;77(3):677-84.PubMedCrossRefGoogle Scholar
  24. 24.
    Pape E, Rezvoy N, Penel N, Salleron J, Martinot V, Guerreschi P, et al. Radiotherapy alone for Merkel cell carcinoma: a comparative and retrospective study of 25 patients. J Am Acad Dermatol. 2011;65(5):983-90.PubMedCrossRefGoogle Scholar
  25. 25.
    Veness M, Foote M, Gebski V, Poulsen M. The role of radiotherapy alone in patients with Merkel cell carcinoma: reporting the Australian experience of 43 patients. Int J Radiat Oncol Biol Phys. 2010:78(3):703-709.PubMedCrossRefGoogle Scholar
  26. 26.
    Fields RC, Busam K, Chou JF, Panageas KS, Pulitzer MP, Allen PJ, et al. Five hundred patients with Merkel cell carcinoma evaluated at a single institution. Ann Surg. 2011;254:465-475.PubMedCrossRefGoogle Scholar
  27. 27.
    Kukko H, Bohling T, Koljonen V, Tukiainen E, Haglung C, Pokhrel A, et al. Merkel cell carcinoma: a population-based epidemiological study in Finland with a clinical series of 181 cases. Eur J Cancer. 2012;48(5):737-42.PubMedCrossRefGoogle Scholar
  28. 28.
    Lok B, Khan S, Mutter R, Liu J, et al. Selective radiotherapy for the treatment of head and neck Merkel cell carcinoma. Cancer. 2012;118(16):3937-3944.PubMedCrossRefGoogle Scholar
  29. 29.
    Mendenhall WM, Kirwan JM, Morris CG, Amdur RJ, Werning JW, Mendenhall NP. Cutaneous Merkel cell carcinoma. Am J Otolaryngol. 2012:33(1);88-92.PubMedCrossRefGoogle Scholar
  30. 30.
    Sundaresan P, Hruby G, Hamilton A, Hong A, Boyer M, Chatfield M, et al. Definitive radiotherapy or chemoradiotherapy in the treatment of Merkel cell carcinoma. Clin Oncol (R Coll Radiol). 2012;24(9):e131-6.PubMedCrossRefGoogle Scholar
  31. 31.
    Santamaria-Barria JA, Boland GM, Yeap BY, Nardi V, Dias-Santagata D, Cusack JC Jr. Merkel cell carcinoma: 30-year experience from a single institution. Ann Surg Oncol. 2013;20(4):1365-73.PubMedCrossRefGoogle Scholar

Copyright information

© Society of Surgical Oncology 2014

Authors and Affiliations

  1. 1.Department of OncologyChristchurch HospitalChristchurchNew Zealand
  2. 2.Department of Radiation OncologyBritish Columbia Cancer AgencyVancouverCanada

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