Outcome of Combined Treatment of Surgery and Adjuvant Radiotherapy in Merkel Cell Carcinoma

Fiedler, Eckhard; Vordermark, Dirk

doi:10.2340/00015555-2895

Cited by 4 publications

(7 citation statements)

References 23 publications

(31 reference statements)

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“…MCC, as other neuroendocrine carcinomas, is responsive to RT and adjuvant RT is advised in the NCCN guidelines in local disease except for small low risk tumours (NCCN). Reports on the survival benefit of adjuvant RT are, however, controversial [11,[37][38][39][40]. To date, the only randomized controlled study on adjuvant RT was conducted by Jouary et al [41] on stage I MCC patients, in which RT to the tumour bed resulted in a significant decrease in local recurrence, but no significant improvement in overall survival.…”

Section: Discussionmentioning

confidence: 99%

Merkel Cell Carcinoma Treatment in Finland in 1986–2016—A Real-World Data Study

Sahi

Their

Gissler

et al. 2020

Cancers

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Merkel cell carcinoma (MCC) is a rare cutaneous carcinoma that has gained enormous interest since the discovery of Merkel cell polyoma virus, which is a causative oncogenic agent in the majority of MCC tumours. Increased research has focused on effective treatment options with immuno-oncology. In this study, we reviewed the real-world data on different treatments given to MCC patients in Finland in 1986–2016. We used the Finnish Cancer Registry database to find MCC patients and the Hospital Discharge Register and the Cause-of-Death Register to obtain treatment data. We identified 376 MCC patients and 33 different treatment entities and/or combinations of treatment. An increase was noted in the incidence of MCC since 2005. Therefore, the cohort was divided into two groups: the “early“ group with time of diagnosis between years 1986 and 2004 and the “late” group with time of diagnosis between 2005 and 2016. The multitude of different treatment combinations is a relatively new phenomenon; before the year 2005, only 11 treatments or treatment combinations were used for MCC patients. Our data show that combining radiation therapy with simple excision provided a survival advantage, which was, however, lost after adjustment for stage or age. Our registry study serves as a baseline treatment efficacy comparison as we move into the age of immunotherapy in MCC. Standardizing the treatment of MCC patients in Finland requires more work on awareness and multidisciplinary co-operation.

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Section: Discussionmentioning

confidence: 99%

Merkel Cell Carcinoma Treatment in Finland in 1986–2016—A Real-World Data Study

Sahi

Their

Gissler

et al. 2020

Cancers

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“…Longer OS was observed for SUR + adjRT versus surgery alone in a study conducted in patients with stage I, II and III disease [16]. Because of the discrepancy between the effects of SUR + adjRT versus surgery in various regions of the body, systemic therapies could also be considered if SUR + adjRT is impossible due to RT contraindication [25]. The diversity of treatments suggests that no clear pathway or standard of care exists for patients with early stage MCC; these findings can support and complement the information already presented by the NCCN guidelines for stage I-III MCC.…”

Section: Discussionmentioning

confidence: 99%

“…One publication showed that patients with stage I, II and III MCC treated with SUR + adjRT had a PFS rate of 86.5% at 5 years. The mean PFS was 155.1 months (CI: 122.4-187.8 months; standard error, 16.7 months) [25].…”

Section: Progression-free Survivalmentioning

confidence: 98%

“…One publication by Harrington et al in patients treated with SUR + adjRT showed decreasing 5-year CSS rates of 88, 70 and 64% for stages I, II and III, respectively (Table 3) [26]. Another publication by Fiedler et al in patients with stage I-III disease treated with SUR + adjRT showed a 5-year DSS rate of 95.7% [25].…”

Section: Other Efficacy End Pointsmentioning

confidence: 99%

“…Five publications in the review identified other efficacy end points, including CSS, DSS, DFS, RFS and recurrencefree survival [16,25,26,29,30]. One such publication defined DFS as time to disease recurrence anywhere in the body or death from any cause and defined DSS as time to death from MCC [16].…”

Section: Other Efficacy End Pointsmentioning

confidence: 99%

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Systematic Literature Review of Current Treatments for Stage I–III Merkel Cell Carcinoma

et al. 2021

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Aim: There is a need to evaluate current treatments for stages I–III of Merkel cell carcinoma (MCC). Materials & methods: A systematic literature review was conducted to understand how patients with stage I–III MCC are treated and assess efficacy, safety, health-related quality of life and economic impact of current therapies. Embase was searched using the following inclusion criteria: publications from 2014 to 2019, in English, with adult patients (≥18 years) with early-stage MCC (i.e., stages I–III) and any interventions/comparators. Publications were excluded if they included only patients with stage IV MCC, had no distinction between early and advanced or metastatic MCC or had no extractable data. Results: A total of 18 retrospective studies were included. Few studies had evidence that surgery plus adjuvant radiotherapy significantly increased survival versus surgery alone in early MCC. Limited safety data were reported in three studies. None of the studies reported data on health-related quality of life or economic impact of treatment in patients with early-stage MCC. Conclusion: Although surgery plus adjuvant radiotherapy was a common treatment, no clear standard of care exists for stages I–III MCC and treatment outcomes need to be improved. All studies were retrospective with a high variability in sample sizes; hence, findings should be interpreted with caution.

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The role of radiotherapy in the updated German S2k guideline for management of Merkel cell carcinoma

Vordermark

Höller²

2023

Strahlenther Onkol

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Merkel cell carcinoma (MCC) is a radiosensitive tumor and the role of radiotherapy in the management of this disease was newly defined in the recently published update of the S2k guideline on Merkel cell carcinoma of the Association of Scientific Medical Societies in Germany (AWMF). While adjuvant radiotherapy of the tumor bed is broadly recommended, irradiation of the regional nodal region can be performed in patients with negative sentinel lymph nodes and high-risk factors. In patients with positive sentinel lymph nodes, it is an alternative to completion lymphadenectomy. The standard dose for adjuvant radiotherapy remains 50 Gy.

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Outcome of Combined Treatment of Surgery and Adjuvant Radiotherapy in Merkel Cell Carcinoma

Cited by 4 publications

References 23 publications

Merkel Cell Carcinoma Treatment in Finland in 1986–2016—A Real-World Data Study

Merkel Cell Carcinoma Treatment in Finland in 1986–2016—A Real-World Data Study

Systematic Literature Review of Current Treatments for Stage I–III Merkel Cell Carcinoma

The role of radiotherapy in the updated German S2k guideline for management of Merkel cell carcinoma

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