Postoperative radiation therapy is associated with a reduced risk of local recurrence among low risk Merkel cell carcinomas of the head and neck
Purpose: Merkel cell carcinoma (MCC) is a rare and often aggressive skin cancer. Typically, surgery is the primary treatment. Postoperative radiation therapy (PORT) is often recommended to improve local control. It is unclear whether PORT is indicated in patients with favorable Stage IA head and nec...
| Main Authors: | , , , , , , , , , , , |
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| Format: | Article |
| Language: | English |
| Published: |
Elsevier
2016-10-01
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| Series: | Advances in Radiation Oncology |
| Online Access: | http://www.sciencedirect.com/science/article/pii/S2452109416300574 |
| _version_ | 1818959017194553344 |
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| author | Seesha R. Takagishi, BS Tessa E. Marx, BS Christopher Lewis, BS Erica S. Tarabadkar, MD Ilsa D. Juhlin Astrid Blom, MD Jayasri G. Iyer, MD Jay J. Liao, MD Yolanda D. Tseng, MD MPhil Teresa Fu, MD Paul Nghiem, MD PhD Upendra Parvathaneni, MBBS FRANZCR |
| author_facet | Seesha R. Takagishi, BS Tessa E. Marx, BS Christopher Lewis, BS Erica S. Tarabadkar, MD Ilsa D. Juhlin Astrid Blom, MD Jayasri G. Iyer, MD Jay J. Liao, MD Yolanda D. Tseng, MD MPhil Teresa Fu, MD Paul Nghiem, MD PhD Upendra Parvathaneni, MBBS FRANZCR |
| author_sort | Seesha R. Takagishi, BS |
| collection | DOAJ |
| description | Purpose: Merkel cell carcinoma (MCC) is a rare and often aggressive skin cancer. Typically, surgery is the primary treatment. Postoperative radiation therapy (PORT) is often recommended to improve local control. It is unclear whether PORT is indicated in patients with favorable Stage IA head and neck (HN) MCC.
Methods and materials: We conducted a retrospective analysis of 46 low-risk HN MCC cases treated between 2006 and 2015. Inclusion criteria were defined as a primary tumor size of ≤ 2 cm, negative pathological margins, negative sentinel lymph node biopsy, and no immunosuppression. Local recurrence (LR) was defined as tumor recurrence within 2 cm of the primary surgical bed and estimated with the Kaplan-Meier method.
Results: Omission of PORT was offered to all 46 patients, of which 23 patients received PORT and 23 did not. No patient received adjuvant chemotherapy. There were no significant differences in surgical margins, tumor size, depth, lympho-vascular invasion status, or demographics between the two patient groups. Median follow-up for all patients was 3.7 years. Six of the 23 patients who did not receive PORT developed an LR. Compared to the group that received PORT, there was a significantly higher risk of LR in the group treated without PORT (26% vs. 0%, P = .02). Median time to LR was 11 months. All local failures were effectively salvaged. There was no difference in MCC-specific and overall survival between the 2 groups.
Conclusions: For patients with HN MCC, omission of PORT was associated with a significantly higher risk of local recurrence even among those patients with the lowest-risk tumors (i.e., Stage IA without immune suppression). Thus, it is important to weigh the benefits of PORT against the side effect profile on a case-specific basis for each patient. |
| first_indexed | 2024-12-20T11:34:57Z |
| format | Article |
| id | doaj.art-bc63418920f4444db2973fe1ae43ea79 |
| institution | Directory Open Access Journal |
| issn | 2452-1094 |
| language | English |
| last_indexed | 2024-12-20T11:34:57Z |
| publishDate | 2016-10-01 |
| publisher | Elsevier |
| record_format | Article |
| series | Advances in Radiation Oncology |
| spelling | doaj.art-bc63418920f4444db2973fe1ae43ea792022-12-21T19:42:09ZengElsevierAdvances in Radiation Oncology2452-10942016-10-011424425110.1016/j.adro.2016.10.003Postoperative radiation therapy is associated with a reduced risk of local recurrence among low risk Merkel cell carcinomas of the head and neckSeesha R. Takagishi, BS0Tessa E. Marx, BS1Christopher Lewis, BS2Erica S. Tarabadkar, MD3Ilsa D. Juhlin4Astrid Blom, MD5Jayasri G. Iyer, MD6Jay J. Liao, MD7Yolanda D. Tseng, MD MPhil8Teresa Fu, MD9Paul Nghiem, MD PhD10Upendra Parvathaneni, MBBS FRANZCR11Department of Medicine/Dermatology, University of Washington, Seattle, WashingtonDepartment of Medicine/Dermatology, University of Washington, Seattle, WashingtonDepartment of Medicine/Dermatology, University of Washington, Seattle, WashingtonDepartment of Medicine/Dermatology, University of Washington, Seattle, WashingtonDepartment of Medicine/Dermatology, University of Washington, Seattle, WashingtonDepartment of Medicine/Dermatology, University of Washington, Seattle, WashingtonDepartment of Medicine/Dermatology, University of Washington, Seattle, WashingtonDepartment of Radiation Oncology, University of Washington, Seattle, WashingtonDepartment of Radiation Oncology, University of Washington, Seattle, WashingtonDepartment of Dermatology, Stanford University School of Medicine, Redwood City, CaliforniaDepartment of Medicine/Dermatology, University of Washington, Seattle, WashingtonDepartment of Radiation Oncology, University of Washington, Seattle, WashingtonPurpose: Merkel cell carcinoma (MCC) is a rare and often aggressive skin cancer. Typically, surgery is the primary treatment. Postoperative radiation therapy (PORT) is often recommended to improve local control. It is unclear whether PORT is indicated in patients with favorable Stage IA head and neck (HN) MCC. Methods and materials: We conducted a retrospective analysis of 46 low-risk HN MCC cases treated between 2006 and 2015. Inclusion criteria were defined as a primary tumor size of ≤ 2 cm, negative pathological margins, negative sentinel lymph node biopsy, and no immunosuppression. Local recurrence (LR) was defined as tumor recurrence within 2 cm of the primary surgical bed and estimated with the Kaplan-Meier method. Results: Omission of PORT was offered to all 46 patients, of which 23 patients received PORT and 23 did not. No patient received adjuvant chemotherapy. There were no significant differences in surgical margins, tumor size, depth, lympho-vascular invasion status, or demographics between the two patient groups. Median follow-up for all patients was 3.7 years. Six of the 23 patients who did not receive PORT developed an LR. Compared to the group that received PORT, there was a significantly higher risk of LR in the group treated without PORT (26% vs. 0%, P = .02). Median time to LR was 11 months. All local failures were effectively salvaged. There was no difference in MCC-specific and overall survival between the 2 groups. Conclusions: For patients with HN MCC, omission of PORT was associated with a significantly higher risk of local recurrence even among those patients with the lowest-risk tumors (i.e., Stage IA without immune suppression). Thus, it is important to weigh the benefits of PORT against the side effect profile on a case-specific basis for each patient.http://www.sciencedirect.com/science/article/pii/S2452109416300574 |
| spellingShingle | Seesha R. Takagishi, BS Tessa E. Marx, BS Christopher Lewis, BS Erica S. Tarabadkar, MD Ilsa D. Juhlin Astrid Blom, MD Jayasri G. Iyer, MD Jay J. Liao, MD Yolanda D. Tseng, MD MPhil Teresa Fu, MD Paul Nghiem, MD PhD Upendra Parvathaneni, MBBS FRANZCR Postoperative radiation therapy is associated with a reduced risk of local recurrence among low risk Merkel cell carcinomas of the head and neck Advances in Radiation Oncology |
| title | Postoperative radiation therapy is associated with a reduced risk of local recurrence among low risk Merkel cell carcinomas of the head and neck |
| title_full | Postoperative radiation therapy is associated with a reduced risk of local recurrence among low risk Merkel cell carcinomas of the head and neck |
| title_fullStr | Postoperative radiation therapy is associated with a reduced risk of local recurrence among low risk Merkel cell carcinomas of the head and neck |
| title_full_unstemmed | Postoperative radiation therapy is associated with a reduced risk of local recurrence among low risk Merkel cell carcinomas of the head and neck |
| title_short | Postoperative radiation therapy is associated with a reduced risk of local recurrence among low risk Merkel cell carcinomas of the head and neck |
| title_sort | postoperative radiation therapy is associated with a reduced risk of local recurrence among low risk merkel cell carcinomas of the head and neck |
| url | http://www.sciencedirect.com/science/article/pii/S2452109416300574 |
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