Should Sentinel Lymph Node Biopsy Status Guide Adjuvant Radiation Therapy in Patients With Merkel Cell Carcinoma?

Ahmad, Tessnim R; Vasudevan, Harish N.; Lazar, Ann; Chan, Jason W.; George, Julia D.; Alvarado, Michael; Yu, Siegrid S.; Daud, Adil; Yom, Sue S.

doi:10.1016/j.adro.2021.100764

Cited by 1 publication

(1 citation statement)

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“…Furthermore, MCCs of the head and neck region, particularly MCC of the lip, have been associated with greater mortality compared with other tumor sites . Poorer prognosis may be associated with close and frequently positive surgical margins from anatomical, functional, and cosmetic limitations as well as lack of correlational value of sentinel lymph node status in the head and neck compared with other sites due to more complex lymphatic anatomy . Given the differences in outcomes of head and neck MCC (HNMCC) compared with MCC in other locations, it is essential to separate out this population to appropriately guide clinical decision-making, give accurate prognostication to patients, and determine the effectiveness of various treatment modalities.…”

Section: Introductionmentioning

confidence: 99%

Survival of Patients With Head and Neck Merkel Cell Cancer

Nayak,

Pickett,

Delisle

et al. 2023

JAMA Netw Open

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ImportanceMerkel cell carcinoma (MCC) is an aggressive cutaneous neuroendocrine carcinoma. Due to its relatively low incidence and limited prospective trials, current recommendations are guided by historical single-institution retrospective studies.ObjectiveTo evaluate the overall survival (OS) of patients in Canada with head and neck MCC (HNMCC) according to American Joint Committee on Cancer 8th edition staging and treatment modalities.Design, Setting, and ParticipantsA retrospective cohort study of 400 patients with a diagnosis of HNMCC between July 1, 2000, and June 31, 2018, was conducted using the Pan-Canadian Merkel Cell Cancer Collaborative, a multicenter national registry of patients with MCC. Statistical analyses were performed from January to December 2022.Main Outcomes and MeasuresThe primary outcome was 5-year OS. Multivariable analysis using a Cox proportional hazards regression model was performed to identify factors associated with survival.ResultsBetween 2000 and 2018, 400 patients (234 men [58.5%]; mean [SD] age at diagnosis, 78.4 [10.5] years) with malignant neoplasms found in the face, scalp, neck, ear, eyelid, or lip received a diagnosis of HNMCC. At diagnosis, 188 patients (47.0%) had stage I disease. The most common treatment overall was surgery followed by radiotherapy (161 [40.3%]), although radiotherapy alone was most common for stage IV disease (15 of 23 [52.2%]). Five-year OS was 49.8% (95% CI, 40.7%-58.2%), 39.8% (95% CI, 26.2%-53.1%), 36.2% (95% CI, 25.2%-47.4%), and 18.5% (95% CI, 3.9%-41.5%) for stage I, II, III, and IV disease, respectively, and was highest among patients treated with surgery and radiotherapy (49.9% [95% CI, 39.9%-59.1%]). On multivariable analysis, patients treated with surgery and radiotherapy had greater OS compared with those treated with surgery alone (hazard ratio [HR], 0.76 [95% CI, 0.46-1.25]); however, this was not statistically significant. In comparison, patients who received no treatment had significantly worse OS (HR, 1.93 [95% CI, 1.26-2.96)].Conclusions and RelevanceIn this cohort study of the largest Canada-wide evaluation of HNMCC survival outcomes, stage and treatment modality were associated with survival. Multimodal treatment was associated with greater OS across all disease stages.

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Section: Introductionmentioning

confidence: 99%