Stereotactic radiosurgery for merkel cell carcinoma brain metastases

Jacob, Arun; Alexandru-Abrams, Daniela; Abrams, Eric M.; Lee, John Y.K.

doi:10.1016/j.jocn.2015.03.013

Cited by 4 publications

(3 citation statements)

References 13 publications

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“…Brain metastases are rare with MCC; single case reports describe the use of whole-brain and stereotactic RT for treatment. [42][43][44] As with other diseases, the approach used would typically depend on the extent of the intracranial and extracranial disease.…”

Section: Metastatic Disease Managementmentioning

confidence: 99%

Radiotherapy in the Multidisciplinary Management of Merkel Cell Carcinoma

Green

Hayman

2018

J Natl Compr Canc Netw

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The management of Merkel cell carcinoma (MCC) requires multidisciplinary care for optimal patient outcomes. Radiotherapy (RT) is most commonly used as adjuvant therapy to improve locoregional control in patients with MCC who undergo surgery. Additionally, it can sometimes be used as definitive monotherapy for patients who decline or are not candidates for surgery and as palliative treatment in those with metastatic MCC. This article discusses the indications, treatment considerations, and recommended dose prescriptions for RT in the management of early- and advanced-stage disease. Considerable hope exists that immunotherapy advances will synergize with RT to further enhance clinical outcomes.

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Section: Metastatic Disease Managementmentioning

confidence: 99%

Radiotherapy in the Multidisciplinary Management of Merkel Cell Carcinoma

Green

Hayman

2018

J Natl Compr Canc Netw

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“…In cases of limited brain metastases, SRS, as characterized by less cognitive deteriorating effects than whole-brain RT, might be preferred over this [ 34 ]. In the pre-avelumab era, Jacob et al reported a successful use of SRS for two metachronous brain metastases in an MCC patient who subsequently died of leptomeningeal spread [ 35 ]. Stereotactic RT showed excellent local control in another patient with limited brain metastases from a primary parotid Merkel-type small cell neuroendocrine carcinoma, which is indistinguishable from classic MCC [ 36 ].…”

Section: Discussionmentioning

confidence: 99%

Introducing Radiotherapy in Metastatic Merkel Cell Carcinoma Patients with Limited Progression on Avelumab: An Effective Step against Primary and Secondary Immune Resistance?

Ferini¹,

Zagardo²,

Critelli

et al. 2023

JPM

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Purpose: To investigate the ability of radiotherapy (RT) to prolong progression-free survival (PFS) and to report treatment-related toxicities among oligoprogressive metastatic Merkel cell carcinoma (mMCC) patients on avelumab. Methods: We retrospectively collected clinical data on mMCC patients who underwent radiotherapy for limited progression on avelumab. Patients were categorized as primary or secondary immune refractory depending on the time of onset of resistance to immunotherapy (at the first or subsequent follow-up visits after avelumab initiation). Pre- and post-RT PFS were calculated. Overall survival (OS) from the first progression treated with RT was also reported. Radiological responses and toxicities were evaluated according to the irRECIST criteria and RTOG scoring system, respectively. Results: Eight patients, including five females, with a median age of 75 years, met our inclusion criteria. The median gross tumor and clinical target volumes at first progression on avelumab were 29.85 cc and 236.7 cc, respectively. The treatment sites included lymph node, skin, brain, and spine metastases. Four patients received more than one course of RT. Most patients were treated with palliative radiation doses (mainly 30 Gy in 3 Gy/day fractions). Two patients were treated with stereotactic RT. Five/eight patients were primary immune refractory. The objective response rate at the first post-RT assessment was 75%, whereas no local failure was reported. The median pre-RT PFS was 3 months. The pre-RT PFS was 37.5% at 6 months and 12.5% at 1 year. The median post-RT PFS was not reached. The post-RT PFS was 60% at 6 months and 1 year. The post-RT OS was 85.7% at 1 year and 64.3% at 2 years. No relevant treatment-related toxicity was observed. After a median follow-up of 18.5 months, 6/8 patients are still alive and continuing on avelumab therapy. Conclusions: Adding radiotherapy to mMCC patients with limited progression on avelumab seems to be safe and effective in prolonging the successful use of immunotherapy, regardless of the type of immune refractoriness.

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“… 6 However, MCC has been shown to be a radiosensitive tumor, and due to the paucity of patients undergoing radiosurgery, Harary et al 6 suggested that radiosurgery could potentially play a role in the management of MCC brain metastasis. Jacob et al 20 reported a case of a patient with two separate MCC brain metastases that were both targeted with SRS and were stable at 5-month follow-up. However, the patient then developed leptomeningeal spread and underwent whole-brain irradiation.…”

Section: Discussionmentioning

confidence: 99%

Merkel cell carcinoma brain metastasis with radiological findings mimicking primary CNS lymphoma: illustrative case

Schreiber²,

Garg

et al. 2022

Journal of Neurosurgery: Case Lessons

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BACKGROUND Merkel cell carcinoma (MCC) is a rare and aggressive neuroendocrine tumor with a high likelihood of distant metastasis. Approximately 30 cases of MCC brain metastasis have been reported. The authors report a case of MCC brain metastasis with imaging findings mimicking primary central nervous system lymphoma. OBSERVATIONS A 69-year-old asymptomatic White female with a past medical history of rheumatoid arthritis and MCC of the right cheek with no known regional or distant spread presented with a right frontal lobe lesion discovered incidentally on a surveillance scan. Brain magnetic resonance imaging revealed a vividly enhancing homogeneous lesion with restricted diffusion on diffusion-weighted imaging and corresponding apparent diffusion coefficient maps. Imaging characteristics suggested a highly cellular mass consistent with primary central nervous system lymphoma; however, given the likelihood of metastasis, resection was recommended. An intraoperative frozen section suggested lymphoma. However, further examination revealed positive cytokeratin 20 staining for a tumor, and a final diagnosis of MCC brain metastasis was made. LESSONS Imaging characteristics of MCC brain metastasis can vary widely. A high level of suspicion should be maintained in a patient with a known history of MCC. Aggressive resection is recommended, regardless of appearance on scans or pathology of frozen sections, because MCC can mimic other intracranial pathologies.

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Stereotactic radiosurgery for merkel cell carcinoma brain metastases

Cited by 4 publications

References 13 publications

Radiotherapy in the Multidisciplinary Management of Merkel Cell Carcinoma

Radiotherapy in the Multidisciplinary Management of Merkel Cell Carcinoma

Introducing Radiotherapy in Metastatic Merkel Cell Carcinoma Patients with Limited Progression on Avelumab: An Effective Step against Primary and Secondary Immune Resistance?

Merkel cell carcinoma brain metastasis with radiological findings mimicking primary CNS lymphoma: illustrative case

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