Predictors of survival and recurrence in the surgical treatment of merkel cell carcinoma of the extremities

Senchenkov, Alex; Barnes, Sunni A.; Moran, Steven L.

doi:10.1002/jso.20647

Cited by 73 publications

(47 citation statements)

References 38 publications

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“…Published regional outcomes are sparse, but available data report crude regional recurrence rates of 0% to 25% (Table 3). 5,10,13,20,21 A series from The University of Texas M. D. Anderson Cancer Center reported a lymph node failure rate of 16% (2 of 12) in lymph node-positive patients treated with therapeutic dissections with or without radiotherapy. 22 Allen et al published a single institution experience from Memorial Sloan-Kettering Cancer Center 5 including 252 patients and reported a 14% (8 of 57) regional recurrence rate in pathologically lymph node-positive patients treated with surgery alone and a similar 13% rate (2 of 16) in patients treated with surgery and adjuvant radiotherapy.…”

Section: Discussionmentioning

confidence: 99%

Radiation monotherapy as regional treatment for lymph node‐positive Merkel cell carcinoma

Fang

Lemos

Douglas

et al. 2010

Cancer

144

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BACKGROUND:Merkel cell carcinoma (MCC) is an aggressive cutaneous malignancy with a high risk of lymph node involvement. To the authors' knowledge, few data have been published to date regarding the optimal regional therapy for lymph node‐positive patients. This cohort study was performed to analyze the outcomes of patients with lymph node‐positive MCC treated with lymph node irradiation as definitive therapy compared with completion lymphadenectomy (CLND).METHODS:Fifty patients with lymph node involvement of MCC at presentation and adequate follow‐up data were included in this analysis. Forty‐three of these patients were enrolled and followed prospectively. Twenty‐six patients presented with microscopic lymph node disease, and 24 patients presented with palpable lymph node involvement.RESULTS:Regional control for patients with microscopically involved lymph nodes was 100% regardless of treatment modality—definitive lymph node irradiation (n = 19) or CLND ± radiotherapy (n = 7) with median follow‐up of 18 months. Patients with clinically positive lymph nodes had 2‐year regional recurrence‐free survival rate of 78% and 73% in the definitive lymph node irradiation (n = 9) and CLND ± radiotherapy (n = 15) groups, respectively (P = .8) with a median follow‐up of 16 months.CONCLUSIONS:To the best of the authors' knowledge, the current study is the largest series published to date of radiation monotherapy as regional treatment for lymph node‐positive MCC. Lymph node irradiation alone to positive regional lymph nodes was found to confer an excellent regional control rate that was comparable to CLND for both microscopic and palpable lymph node disease. There was no difference noted with regard to overall survival. Given their similar efficacy, the choice between these lymph node therapies may be based on the clinical scenario and anticipated side effect profiles. Cancer 2010. © 2010 American Cancer Society.

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Section: Discussionmentioning

confidence: 99%

Radiation monotherapy as regional treatment for lymph node‐positive Merkel cell carcinoma

Fang

Lemos

Douglas

et al. 2010

Cancer

144

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“…21 Pre-operative lymphoscintigraphy has been shown to reliably detect sentinel nodes also in Merkel cell carcinoma 22,23 ; sentinel lymph node biopsy is thus recommended by many authors. 17,24,25 Vascular invasion is frequently seen in Merkel cell carcinoma tumor samples. In routine hematoxylineosin staining, vascular invasion has been observed in 38-60% of the samples.…”

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confidence: 99%

Vascular invasion is an early event in pathogenesis of Merkel cell carcinoma

et al. 2010

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This study investigated vascular and especially lymphovascular invasion in primary Merkel cell carcinoma and its value as a prognostic factor. Paraffin-embedded blocks prepared from tumor samples obtained from126 patients diagnosed with Merkel cell carcinoma in 1979-2004 were immunohistochemically stained using antibodies CD31 and D2-40 to detect intravascular tumor emboli. This finding was compared with the clinical data and the disease outcome. Intravascular tumor cells were observed in 117 (93%) of the samples. The majority, 83 (66%), showed only lymphovascular invasion. Only blood vascular invasion was seen in four (3%) samples. In all, 30 (24%) samples demonstrated both lymphovascular invasion and blood vascular invasion. In only nine (7%) samples, there was no invasion within the vascular structures. The tumors lacking invasion were significantly smaller (Po0.01 and a ¼ 0.050) than those with vascular invasion, although lymphovascular invasion was observed even in the smallest tumor (0.3 cm) of this study. Already in the early stages of the disease, Merkel cell carcinoma seems to have the capacity to penetrate vessel walls. Our finding of the high frequency of lymphovascular invasion might therefore explain the extremely aggressive clinical behavior of Merkel cell carcinoma. This may support the role of sentinel node biopsy even in the case of very small primary Merkel cell carcinoma tumors.

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“…7,35,36 Regional nodal metastases have been reported (either occult or clinically positive) in up to 30%-40% of patients, including those undergoing sentinel lymph node biopsy in clinically node-negative regional basins and those who present with clinically involved regional nodal metastases. 13,[35][36][37][38][39] Patients may present with palpable clinical nodal disease up to 30% of the time, and nodal involvement typically precedes the development of distant metastasis. 40,41 Therefore, adequate assessment of the regional nodal basin and proper treatment are critical for staging, individualizing treatment, and providing an accurate prognosis.…”

Section: Treatment Of Regional MCCmentioning

confidence: 99%