Primary cutaneous neuroendocrine (Merkel cell or trabecular carcinoma) tumour of the skin: a radioresponsive tumour

Ashby, Michael; Jones, D.H.; Tasker, A; Blackshaw, A.J.

doi:10.1016/s0009-9260(89)80043-1

Cited by 66 publications

(31 citation statements)

References 10 publications

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“…Both patients were free of disease at 38 months and 45 months, respectively. Other case reports of patients treated with radiation as monotherapy have been published with varying results, 12,[30][31][32][33][34] and small numbers have precluded the ability to draw any conclusions. In this series, 28 patients who received lymph node irradiation without CLND had control rates comparable to the surgical cohort for both microscopic and palpable lymph node presentations.…”

Section: Discussionmentioning

confidence: 99%

Radiation monotherapy as regional treatment for lymph node‐positive Merkel cell carcinoma

Fang

Lemos

Douglas

et al. 2010

Cancer

145

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BACKGROUND:Merkel cell carcinoma (MCC) is an aggressive cutaneous malignancy with a high risk of lymph node involvement. To the authors' knowledge, few data have been published to date regarding the optimal regional therapy for lymph node‐positive patients. This cohort study was performed to analyze the outcomes of patients with lymph node‐positive MCC treated with lymph node irradiation as definitive therapy compared with completion lymphadenectomy (CLND).METHODS:Fifty patients with lymph node involvement of MCC at presentation and adequate follow‐up data were included in this analysis. Forty‐three of these patients were enrolled and followed prospectively. Twenty‐six patients presented with microscopic lymph node disease, and 24 patients presented with palpable lymph node involvement.RESULTS:Regional control for patients with microscopically involved lymph nodes was 100% regardless of treatment modality—definitive lymph node irradiation (n = 19) or CLND ± radiotherapy (n = 7) with median follow‐up of 18 months. Patients with clinically positive lymph nodes had 2‐year regional recurrence‐free survival rate of 78% and 73% in the definitive lymph node irradiation (n = 9) and CLND ± radiotherapy (n = 15) groups, respectively (P = .8) with a median follow‐up of 16 months.CONCLUSIONS:To the best of the authors' knowledge, the current study is the largest series published to date of radiation monotherapy as regional treatment for lymph node‐positive MCC. Lymph node irradiation alone to positive regional lymph nodes was found to confer an excellent regional control rate that was comparable to CLND for both microscopic and palpable lymph node disease. There was no difference noted with regard to overall survival. Given their similar efficacy, the choice between these lymph node therapies may be based on the clinical scenario and anticipated side effect profiles. Cancer 2010. © 2010 American Cancer Society.

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Section: Discussionmentioning

confidence: 99%

Radiation monotherapy as regional treatment for lymph node‐positive Merkel cell carcinoma

Fang

Lemos

Douglas

et al. 2010

Cancer

145

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“…9,10,25-28 Although 1 study did not find adjuvant radiation effective in 10 patients treated, 10 and, under laboratory controlled conditions, a range of radiosensitivity was observed, 9 there are many studies to support that Merkel cell carcinoma is responsive to radiation treatment. 9,10,[25][26][27][28][29] One study found a complete response rate of 96% (22 of 23 sites of measurable disease irradiated). 25 Another study noted 3 of 4 patients had complete response to radiotherapy.…”

Section: Discussionmentioning

confidence: 99%

“…25 Another study noted 3 of 4 patients had complete response to radiotherapy. 26 In a largest single institution study of 80 patients, the recurrence rate was reduced from 100% in patients treated by surgery alone to 29% with addition of adjuvant radiation therapy, that is, all 38 patients who were treated by surgery alone relapsed, mostly nodal diseases, but only 10 of the 34 patients (29%) relapsed with adjuvant radiation therapy, mostly nodal and distant metastasis. 11 This did not take into account that patients who were referred for adjuvant radiation therapy might have worse disease or "inadequate" surgery in which the surgeon felt the need for further adjuvant therapy.…”

Section: Discussionmentioning

confidence: 99%

Treatment of Merkel Cell Carcinoma

Eng¹,

Boersma²,

Fuller³

et al. 2004

American Journal of Clinical Oncology

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Purpose: The purpose of this study was to evaluate the treatment of Merkel cell carcinoma. Materials and Methods: We reviewed 85 cases of Merkel cell carcinoma. There were 68 males and 17 females. The majority of cases involved head and neck sites (48%), followed by the extremities (38%) and trunk (14%). Sixty-seven percent of the patients had stage I disease that was localized to the skin of origin at presentation. Twenty-five percent and 8% were stage II (nodal metastasis) and stage III (distant metastasis), respectively. Surgical intervention included local or wide local excision Ϯ nodal dissection (68%), radical resection Ϯ nodal dissection (22%), and amputation (4%). Five patients (6%) underwent biopsy only because of metastatic disease or unresectability at presentation. Fifty-one percent received adjuvant therapy consisting of external beam radiation therapy and/or combination chemotherapy. Results: With an average follow-up time of 39.5 months, 12% had persistent disease and 40% had recurrent disease. The median time to recurrence was 8 months with a mean of 10.6 months. Although the addition of adjuvant therapy did not affect survival, the recurrence rate was 32.5% for surgery Ϯ adjuvant radiation therapy Ϯ chemotherapy as compared with 52.7% for surgery-only patients. Although the 40.7% recurrence rate for patients receiving surgery and adjuvant radiation therapy was approximately the same as for patients receiving surgery and adjuvant chemotherapy (40%), the effect of systemic chemotherapy on recurrence is less clear as a result of the small number of patients who received such therapy. Although tumor size and site of presentation were not observed to be statistically significant in overall survival, significant differences were observed based on sex and tumor stage. For females, the median survival time was 96 months (mean, 94.5 months) compared with 63 months (mean, 76.8 months) for males. This difference was significant (P Ͻ 0.01). Patients presenting with low-stage (stage I) disease had a significant (P Ͻ 0.01) survival benefit when compared with high-stage individuals (stages II and III). The 5-year actuarial survival rates were 68% and 42%, respectively. Conclusion:In this retrospective study, surgery remains the primary modality for Merkel cell carcinoma, and adjuvant radiation therapy Ϯ systemic chemotherapy reduces local recurrence. Female patients and those who present with early-stage disease appear to have a better prognosis.

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“…Despite contrary published opinions, in most practical clinical situations, these tumors predominantly occur in frail elderly people in whom the avoidance of extensive surgery is particularly desirable [24]. Often radiation oncologists receive referrals to avoid further surgery, which might cause untoward cosmetic or functional results.…”

Section: Discussionmentioning

confidence: 99%

Multimodality management for 145 cases of Merkel cell carcinoma

Tai

Assouline

et al. 2009

Med Oncol

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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.

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Primary cutaneous neuroendocrine (Merkel cell or trabecular carcinoma) tumour of the skin: a radioresponsive tumour

Cited by 66 publications

References 10 publications

Radiation monotherapy as regional treatment for lymph node‐positive Merkel cell carcinoma

Radiation monotherapy as regional treatment for lymph node‐positive Merkel cell carcinoma

Treatment of Merkel Cell Carcinoma

Multimodality management for 145 cases of Merkel cell carcinoma

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