Early aggressive treatment for Merkel cell carcinoma improves outcome

Kokoska, Evan R.; Kokoska, Mimi S.; Collins, Brian T.; Stapleton, Diane; Wade, Terence P.

doi:10.1016/s0002-9610(97)00193-1

Cited by 174 publications

(158 citation statements)

References 20 publications

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“…Early aggressive treatment for MCC, including prophylactic lymph node dissection and adjuvant radiotherapy (RT), has been advocated. 17 However, both are associated with risks.…”

Section: Discussionmentioning

confidence: 99%

Features Predicting Sentinel Lymph Node Positivity in Merkel Cell Carcinoma

Schwartz

Griffith

Lowe

et al. 2011

JCO

135

107

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A B S T R A C T PurposeMerkel cell carcinoma (MCC) is a relatively rare, potentially aggressive cutaneous malignancy. We examined the clinical and histologic features of primary MCC that may correlate with the probability of a positive sentinel lymph node (SLN). MethodsNinety-five patients with MCC who underwent SLN biopsy at the University of Michigan were identified. SLN biopsy was performed on 97 primary tumors, and an SLN was identified in 93 instances. These were reviewed for clinical and histologic features and associated SLN positivity. Univariate associations between these characteristics and a positive SLN were tested for by using either the 2 or the Fisher's exact test. A backward elimination algorithm was used to help create a best multiple variable model to explain a positive SLN. ResultsSLN positivity was significantly associated with the clinical size of the lesion, greatest horizontal histologic dimension, tumor thickness, mitotic rate, and histologic growth pattern. Two competing multivariate models were generated to predict a positive SLN. The histologic growth pattern was present in both models and combined with either tumor thickness or mitotic rate. ConclusionIncreasing clinical size, increasing tumor thickness, increasing mitotic rate, and infiltrative tumor growth pattern were significantly associated with a greater likelihood of a positive SLN. By using the growth pattern and tumor thickness model, no subgroup of patients was predicted to have a lower than 15% to 20% likelihood of a positive SLN. This suggests that all patients presenting with MCC without clinical evidence of regional lymph node disease should be considered for SLN biopsy.

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“…Early aggressive treatment for MCC, including prophylactic lymph node dissection and adjuvant radiotherapy (RT), has been advocated. 17 However, both are associated with risks.…”

Section: Discussionmentioning

confidence: 99%

Features Predicting Sentinel Lymph Node Positivity in Merkel Cell Carcinoma

Schwartz

Griffith

Lowe

et al. 2011

JCO

135

107

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“…8 This tumor has traditionally been managed with surgery alone, and 2.0-to 3.0-cm margins have been generally recommended. 9,10 However, Gillenwater et al 11 recently reported no difference in outcome among 18 patients with margins less than 1.0 cm, 1.0 to 2.0 cm, or greater than 2.0 cm.…”

Section: Commentmentioning

confidence: 99%

Radiotherapy Alone for Primary Merkel Cell Carcinoma

Mortier

Mirabel²,

Fournier³

et al. 2003

Arch Dermatol

128

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Background: Merkel cell carcinoma is a rare and potentially aggressive cancer of the skin. Cumulative data from small retrospective series have supported treatment by wide excision and adjuvant radiotherapy. However, wide excision may be difficult to perform in patients with tumors of the head and neck or in older populations with comorbidities that may be incompatible with general anesthesia.Observations: Nine patients (group 1) with stage I (without lymph node involvement) Merkel cell carcinoma primary tumors were treated in our center by radiotherapy alone. The rate of recurrence was compared between this group and 17 additional patients (group 2) with stage I Merkel cell carcinoma who received conventional treatment (surgery followed by radiotherapy).Results: The median follow-up was 3.0 years (range, 8 months to 7 years) for group 1 and 4.6 years (range, 5 months to 11 years) for group 2. During this period, we observed 1 relapse and 1 progression of disease in group 2. No statistical difference was found in overall and disease-free survival between the 2 groups of patients. Conclusion:Thisstudydemonstratesthepossibilityoftreating inoperable Merkel cell carcinoma by radiotherapy alone, with outcomes similar to those of classic treatment.

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“…The majority of published studies support the use of adjuvant RT after complete resection of the tumor [9, 12,19,20,21,22]. Most of these studies showed a reduction in local relapse rate, with 0–33% for patients treated with adjuvant RT and 21–89% for patients treated only with surgery [4, 9,23,24,25,26,27]. In addition, some studies showed a reduction in regional recurrence rate from 50–94 to 19–27% with the use of adjuvant RT [9, 23, 24, 26].…”

Section: Discussionmentioning

confidence: 99%

Merkel Cell Carcinoma of the Skin: A Retrospective Study of 24 Cases by the Hellenic Cooperative Oncology Group

Pectasides

Papaxoinis²,

Pectasides³

et al. 2007

Oncology

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Background: The purpose of this retrospective study was to present the epidemiological and clinical characteristics of 24 patients with Merkel cell carcinoma of the skin (MCC) and their response to various therapeutic modalities. Methods: The tumor registry of the Hellenic Cooperative Oncology Group was used to identify patients with MCC diagnosed between 1986 and 2006. Results: The most frequent primary sites were the extremities (50%), followed by the head (33%) and the trunk (17%). Median time of follow-up was 24 months. Sixteen patients were initially diagnosed with stage I, 5 patients with stage II, and 3 patients with stage III (metastatic) disease. Six patients with stage I disease received adjuvant chemotherapy (CT) and/or radiotherapy (RT). All patients with stage I disease treated only with surgery relapsed, whereas 33% of the patients treated with adjuvant therapy recurred. All patients with stage II disease received adjuvant treatment. Among them, 2 patients relapsed. Disease-free survival (DFS) and overall survival (OS) did not differ significantly between patients with stage I and II disease (stage I: 4-year DFS 27%, 4-year OS 56%; stage II: 4-year DFS 60%, 4-year OS 80%). Patients treated with adjuvant therapy had significantly better DFS than those treated only with surgery (p = 0.012), but OS did not differ significantly (adjuvant group: 4-year DFS 59%, 4-year OS 74%; surgery group: 4-year DFS 10%, 4-year OS 50%). Eleven patients with locally advanced or metastatic disease received CT. The response rate was 73% (complete remission 18%), median progression-free survival was 10 months and median OS was 14 months. Complete remission was achieved in 2 other cases, with the addition of RT after CT. Conclusions: MCC is an aggressive neoplasm with significant chemosensitivity and radiosensitivity, but poor outcome. The role of adjuvant treatment should be further investigated.

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Early aggressive treatment for Merkel cell carcinoma improves outcome

Cited by 174 publications

References 20 publications

Features Predicting Sentinel Lymph Node Positivity in Merkel Cell Carcinoma

Features Predicting Sentinel Lymph Node Positivity in Merkel Cell Carcinoma

Radiotherapy Alone for Primary Merkel Cell Carcinoma

Merkel Cell Carcinoma of the Skin: A Retrospective Study of 24 Cases by the Hellenic Cooperative Oncology Group

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