Merkel Cell Carcinoma: 27-year Experience at the Peter MacCallum Cancer Center

Abstract

Materials/Methods: We performed a retrospective review of 120 consecutive extremity STS cases from 1992-2007 at our institution. Adult stage I-III extremity STS patients who underwent a full course of adjuvant RT with limb sparing intent were included. Four patients were excluded from IORT: 2 re-irradiation, and 2 with disease progression declined EBRT. Seven patients were excluded from EBRT: 4 histologic (Ewing's, Desmoplastic Small Round Cell Tumor, Dermatofibrosarcoma protruberans, Aggressive Fibromatosis), and single patients with incomplete RT, synchronous lung cancer, and unrelated death. A total of 24 IORT and 53 EBRT patients were analyzed for demographics, recurrence vs. primary, stage, grade, surgical margins, bone resection or joint reconstruction (BR-JR), and systemic therapy and assessed for WC, RT delay, LC, DFS, and OS. WC was defined as surgery or hospitalization for wound care. The cutoff between early and late WC was 90 days after surgery. IORT was delivered with a Mobetron linear accelerator and EBRT with standard photon therapy. Results: Mean dose was 12.5 Gy of IORT (5-15 Gy) plus 50 Gy of EBRT (45-68.4 Gy) or 59.4 Gy of EBRT alone (50-70.2 Gy). Median follow-up was similar at 2.35 and 2.65 years in IORT and EBRT and there was no difference in delay of starting or completing RT. They had similar characteristics except deep tumors (100% IORT and 85% in EBRT, p = 0.042), BR-JR (0 IORT and 18% EBRT, p = 0.05), and histology (p = 0.021) calculated by Fisher's Exact test and Mann-Whitney Ranked Sum Test. Kaplan-Meier analysis at 2 years shows similar limb sparing (100% and 96%, p = 0.35), LC (85% and 95%, p = 0.95), DFS (61% and 73%, p = 0.11) and OS (88% and 78%, p = 0.82) for IORT and EBRT and showed no difference when censoring superficial tumors or BR-JR. Late WC was higher in IORT (24% and 4%, p = 0.013); however, early WC (4% and 9%) and total WC (28% and 15%) were not significantly different. BR-JR was not associated with early, late, or total WC in EBRT. Univariate analysis showed late WC was only associated with IORT, and the odds ratio for WC was 8.5 (95% CI 1.57-45.98). Conclusions: IORT does not delay RT for STS of the extremity and has equivalent LC, DFS, OS, and limb sparing compared to EBRT alone, despite a bias of more deep tumors. IORT can be used to treat extremity STS; however, late WC in IORT is significantly increased with uncertain clinical significance.Purpose/Objective(s): Doxorubicin-based chemotherapy improves the survival of Hodgkin lymphoma (HL) patients, and has become a standard component of initial treatment. However, most studies of cardiac morbidity among HL patients precede the widespread use of this cardiotoxic drug, and do not provide age and sex-adjusted estimates of absolute risk. S122I.

Sentinel lymph node mapping for defining site and extent of elective radiotherapy management of regional nodes in Merkel cell carcinoma: A pilot case series

“…2 MCC behaves aggressively, with a propensity for local, regional, in-transit and distant recurrence which typically occurs within 2 years. 3 Locoregional control is 75% at 3 years. 4 Five-year survival rates range from 30% to 64%.…”