Recurrence after complete resection and selective use of adjuvant therapy for stage I through III Merkel cell carcinoma Journal Article


Authors: Fields, R. C.; Busam, K. J.; Chou, J. F.; Panageas, K. S.; Pulitzer, M. P.; Allen, P. J.; Kraus, D. H.; Brady, M. S.; Coit, D. G.
Article Title: Recurrence after complete resection and selective use of adjuvant therapy for stage I through III Merkel cell carcinoma
Abstract: BACKGROUND: Merkel cell carcinoma (MCC) is a rare cutaneous neuroendocrine neoplasm whose natural history is poorly understood. Here, the authors describe their experience with a large cohort of patients who were treated at a single institution to describe patterns of recurrence after curative therapy. METHODS: Review of a prospective database was performed. Patient-related, tumor-related, and treatment-related variables were recorded, and the site and timing of initial recurrence were recorded. Factors associated with receipt of adjuvant therapy and recurrence were determined. RESULTS: In total, 364 patients with stage I through III MCC who underwent complete resection were identified. Adjuvant local radiation therapy (RT), lymph node RT, and chemotherapy were received selectively by 23%, 23%, and 15% of patients, respectively. Factors associated with the receipt of adjuvant therapy included younger age, primary tumor features (larger size, lymphovascular invasion [LVI], positive margin excision), and increasing pathologic stage. With median follow-up of 3.6 years, 108 patients (30%) developed a recurrence, including 11 local recurrences (3%), 12 in-transit recurrences (3%), 43 lymph node recurrences (12%), and 42 distant recurrences (12%). Clinically involved lymph nodes, primary tumor LVI, and a history of leukemia/lymphoma were predictive of recurrence. The majority of recurrences (80%) occurred in patients who had clinically involved lymph nodes or patients who did not undergo pathologic lymph node evaluation. CONCLUSIONS: A low recurrence rate in patients with clinically lymph node-negative MCC was achieved with adequate surgery (including sentinel lymph node biopsy) and the selective use of adjuvant RT for high-risk tumors. In contrast, patients with clinically lymph node-positive MCC had significantly higher rates of recurrence, especially distant recurrence. The authors concluded that contemporary natural history studies are critical in designing treatment pathways and clinical trials for MCC. © 2011 American Cancer Society.
Keywords: adult; cancer chemotherapy; aged; middle aged; leukemia; cancer surgery; major clinical study; review; cancer recurrence; cisplatin; cancer adjuvant therapy; cancer radiotherapy; chemotherapy, adjuvant; combined modality therapy; radiotherapy, adjuvant; chemotherapy; treatment; cancer staging; follow up; lymph node dissection; carboplatin; skin neoplasms; etoposide; recurrence; age; cancer invasion; lymph node; lymphoma; surgery; radiation therapy; merkel cell carcinoma; merkel cell tumor; carcinoma, merkel cell; outcomes; lymphatic irradiation
Journal Title: Cancer
Volume: 118
Issue: 13
ISSN: 0008-543X
Publisher: Wiley Blackwell  
Date Published: 2012-06-01
Start Page: 3311
End Page: 3320
Language: English
DOI: 10.1002/cncr.26626
PROVIDER: scopus
PUBMED: 22072529
DOI/URL:
Notes: --- - "Export Date: 2 July 2012" - "CODEN: CANCA" - "Source: Scopus"
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MSK Authors
  1. Joanne Fu-Lou Chou
    153 Chou
  2. Dennis Kraus
    258 Kraus
  3. Melissa P Pulitzer
    126 Pulitzer
  4. Peter Allen
    436 Allen
  5. Ryan Courtney Fields
    19 Fields
  6. Katherine S Panageas
    325 Panageas
  7. Mary Sue Brady
    164 Brady
  8. Daniel Coit
    415 Coit
  9. Klaus J Busam
    535 Busam