All delays before radiotherapy risk progression of Merkel cell carcinoma

Abstract

Prolonged waiting times for radiotherapy have resulted in many centres assigning priorities to various patient or diagnostic groups. A high risk of progression on a waiting list is one factor that would reasonably influence the priority. The present descriptive study of 27 patients with Merkel cell carcinoma (MCC) found that a median wait of 24 days for radiotherapy is associated with a high risk of progression. Eleven (41%) of 27 patients developed progressive disease, including five (45%) of 11 patients waiting for adjuvant radiotherapy. Patients treated adjuvantly also had longer waiting times prior to their initial radiotherapy consultation (median 41 days), which may have contributed to the rate of progression. Merkel cell carcinoma is an aggressive but curable malignancy and appropriate management should include efforts to minimize all potential delays prior to the commencement of radiotherapy.

Merkel Cell Carcinoma: Current Management and Controversies

“…Radiotherapy techniques were not clearly defined and doses ranged between 45 and 50 Gy to primary sites, 45 and 60 Gy to nodal basins and the start of radiotherapy was only within 4 months of surgery. This is relevant as recurrences typically occur early, therefore delaying adjuvant or even primary radiation may be significant [36].…”

Merkel cell carcinoma: what we know now

“…MCC has a tendency to invade dermal lymphatics early in disease progression [93]. A study of 27 patients found that a median wait of 24 days for radiotherapy is associated with a high risk of progression [94,95].…”

Multimodality management for 145 cases of Merkel cell carcinoma

“…For example, one of our patients died untreated, after waiting for 4 months for appropriate investigations and therapy. Another study found that a median wait of [24 days for RT is associated with a high risk of progression [26].…”