Multimodality management for 145 cases of Merkel cell carcinoma

Abstract

The results of the multimodality management of 145 cases of cutaneous Merkel cell carcinoma (MCC) are reported herein. Patient information was obtained from medical records of four Canadian institutions and one French institution. These data included ages, pathological stages, disease sites, histological and treatment details. Cause-specific survival (CSS), overall survival (OS) and disease-free survival (DFS) rates were analyzed by the log-rank and Kaplan-Meier methods. From 1988 to 2007, 145 cases were analyzed. There were 74 men and 71 women. Median age was 78 years (range 47-95.2). Median follow-up was 21.5 months (range 0.5-169.1). During the follow-up period, 37 local, 37 regional nodal and 15 distant recurrences were determined to be either solitary or multifocal sites of treatment failure. Relapsing patients were treated with multimodal treatments provided that their general state of health did not preclude this approach. Either initially and/or at relapse, 30 patients were treated with either multiagent (mostly etoposide with cisplatin or carboplatin) or single-agent chemotherapy, including irinotecan, taxotere and topotecan. In conclusion, recurrence should be treated with multimodalities. Our experience of long-term survivors after treatment of recurrence is encouraging.

Diagnosis and treatment of Merkel Cell Carcinoma. European consensus-based interdisciplinary guideline

“…These regimens combine in various ways carboplatin, cisplatin and etoposide, cyclophosphamide with vincristine, doxorubicin, prednisone, bleomycin or 5-fluorouracil. Initial regression is frequent with a response rate up to 75% [38][39][40][41] but of short duration with a median overall survival rate of 9 months and high toxicity in elderly patients. Among these regimens, one of the most frequently used for patients with good performance status is a combination of cisplatin and etoposide (cisplatin 60-80 mg/m 2 IV on day 1 plus etoposide 80-120 mg/m 2 IV on days 1-3 every 21-28 days or carboplatin AUC 5 IV on day 1 plus etoposide 80-100 mg/m 2 IV on days 1-3 every 28 days: (http://www.nccn.org/professionals/physician_gls/pdf/ sclc.pdf).…”

Benefits of combined modality treatment of Merkel cell carcinoma of the head and neck: single institution experience

“…40 Twenty-six per cent of patients in this study received chemotherapy as part of their primary treatment, and this was administered as an adjuvant to surgery and radiotherapy. Merkel cell carcinoma has been shown to be chemosensitive, 38,[41][42][43][44] and response rates to carboplatin and etoposide, the two agents used most commonly at our institute, have been reported at 60 per cent. 4,38,41 Our study demonstrated no improvements in locoregional control (Table III) or survival (Table IV) in the cohort of patients who received chemotherapy, even after correcting for diseasespecific factors.…”

Prise en charge de 145 cas de carcinomes à cellules de Merkel

“…La plupart des séries publiées dans la littérature décrivent le CCM comme une maladie radiosensible et chimiosensible [2,3,[11][12][13][14][15][16][17][18][19][20]. Les données récentes plaident pour une prise en charge multidisciplinaire, incluant chirurgie de la tumeur primitive avec des marges d'exérèse larges, exérèse du ganglion sentinelle et radiothérapie adjuvante dans la plupart des cas.…”

“…Du fait de la rareté de cette pathologie, les études prospectives sur de larges séries sont très difficiles à mettre en oeuvre, et la littérature médicale concernant le CCM est essentiellement composée de petites séries rétrospectives. Le traitement chirurgical avec résection large et complète de la tumeur primitive et la radio- thérapie complémentaire sont généralement acceptés, toutefois, il n'existe pas de consensus international concernant la prise en charge optimale de cette maladie [3]. En effet, les données rapportées dans les séries rétrospectives sont souvent imprécises, en particulier le mode chirurgical et la taille des marges d'exérèse, le traitement adjuvant, la prise en charge de la rechute locorégionale, et les options thérapeutiques restent encore débattues.…”