The role of radiotherapy alone in patients with merkel cell carcinoma: Reporting the australian experience of 43 patients

Veness, Michael, Foote, Matthew, Gebski, Val and Poulsen, Michael (2010) The role of radiotherapy alone in patients with merkel cell carcinoma: Reporting the australian experience of 43 patients. International Journal of Radiation Oncology Biology Physics, 78 3: 703-709. doi:10.1016/j.ijrobp.2009.08.011


Author Veness, Michael
Foote, Matthew
Gebski, Val
Poulsen, Michael
Title The role of radiotherapy alone in patients with merkel cell carcinoma: Reporting the australian experience of 43 patients
Journal name International Journal of Radiation Oncology Biology Physics   Check publisher's open access policy
ISSN 0360-3016
1879-355X
0145-1464
Publication date 2010-11-01
Year available 2009
Sub-type Article (original research)
DOI 10.1016/j.ijrobp.2009.08.011
Volume 78
Issue 3
Start page 703
End page 709
Total pages 7
Place of publication Philadelphia, PA, United States
Publisher Elsevier
Collection year 2011
Language eng
Formatted abstract
Purpose: To review the role of radiotherapy (RTx) alone in patients with Merkel cell carcinoma (MCC).

Methods and Materials:
The records of 43 patients with MCC treated with RTx alone between 1993 and 2007 at the Westmead and Royal Brisbane/Mater Hospitals, Australia, were reviewed. Multivariate analysis was performed by use of Cox regression analysis.

Results:
The median age was 79 years (range, 48-91 years) in 19 women (44%) and 24 men (56%). All patients were white, and 5 (12%) had immunosuppression. A majority (56%) underwent irradiation at initial diagnosis, with the remainder (44%) treated in the relapse setting. The median duration of follow-up was 39 months. The head and neck comprised the most frequently treated site (47%). The median maximum lesion size was 30 mm (range, 5-130 mm). Relapse developed in 60% of patients, with most being out-of-field relapses. The in-field control rate was 75%. Most out-of-field relapses were to visceral organs. Relapse developed outside the irradiated field in 53% of patients. On multivariate analysis, only nodal status (negative nodes vs. nodes present) was significantly associated with relapse-free survival, with p = 0.005 (hazard ratio, 0.25; 95% confidence interval, 0.96-0.663). Overall survival at 2 and 5 years was 58% and 37%, respectively.

Conclusions:
Patients with MCC treated with RTx have a high likelihood of obtaining in-field control. Doses of 50 to 55 Gy in 20 to 25 fractions are recommended. A minority of patients are cured, with many dying of systemic relapse. Lower dose fractionation schedules (e.g., 25 Gy in 5 fractions) may be considered in patients with a very poor performance status. © 2010 Elsevier Inc. All rights reserved.
Keyword Merkel cell carcinoma
Neuroendocrine
Radiotherapy
Small-cell carcinoma
Q-Index Code C1
Q-Index Status Confirmed Code
Institutional Status UQ
Additional Notes Available online 24 November 2009

Document type: Journal Article
Sub-type: Article (original research)
Collections: 2010 Higher Education Research Data Collection
School of Medicine Publications
 
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Created: Sun, 31 Oct 2010, 00:09:07 EST