Does chemotherapy improve survival in high-risk Stage I and II Merkel cell carcinoma of the skin?

Poulsen, MG, Rischin, D, Porter, I, Walpole, E, Harvey, J, Hamilton, C, Keller, J and Tripcony, L (2006) Does chemotherapy improve survival in high-risk Stage I and II Merkel cell carcinoma of the skin?. International Journal of Radiation Oncology Biology Physics, 64 1: 114-119. doi:10.1016/j.ijrobp.2005.04.042


Author Poulsen, MG
Rischin, D
Porter, I
Walpole, E
Harvey, J
Hamilton, C
Keller, J
Tripcony, L
Title Does chemotherapy improve survival in high-risk Stage I and II Merkel cell carcinoma of the skin?
Journal name International Journal of Radiation Oncology Biology Physics   Check publisher's open access policy
ISSN 0360-3016
Publication date 2006
Sub-type Article (original research)
DOI 10.1016/j.ijrobp.2005.04.042
Volume 64
Issue 1
Start page 114
End page 119
Total pages 6
Editor J. D. Cox
Place of publication USA
Publisher Elsevier Inc
Collection year 2006
Language eng
Subject C1
321015 Oncology and Carcinogenesis
730108 Cancer and related disorders
Abstract Purpose: The effectiveness of synchronous carboplatin, etoposide, and radiation therapy in improving survival was evaluated by comparison of a matched set of historic control subjects with patients treated in a prospective Phase II study that used synchronous chemotherapy and radiation and adjuvant chemotherapy. Patients and Methods: Patients were included in the analysis if they had disease localized to the primary site and nodes, and they were required to have at least one of the following high-risk features: recurrence after initial therapy, involved nodes, primary size greater than 1 cm, or gross residual disease after surgery. All patients who received chemotherapy were treated in a standardized fashion as part of a Phase II study (Trans-Tasman Radiation Oncology Group TROG 96:07) from 1997 to 2001. Radiation was delivered to the primary site and nodes to a dose of 50 Gy in 25 fractions over 5 weeks, and synchronous carboplatin (AUC 4.5) and etoposide, 80 mg/m(2) i.v. on Days 1 to 3, were given in Weeks 1, 4, 7, and 10. The historic group represents a single institution's experience from 1988 to 1996 and was treated with surgery and radiation alone, and patients were included if they fulfilled the eligibility criteria of TROG 96:07. Patients with occult cutaneous disease were not included for the purpose of this analysis. Because of imbalances in the prognostic variables between the two treatment groups, comparisons were made by application of Cox's proportional hazard modeling. Overall survival, disease-specific survival, locoregional control, and distant control were used as endpoints for the study. Results: Of the 102 patients who had high-risk Stage I and II disease, 40 were treated with chemotherapy (TROG 96:07) and 62 were treated without chemotherapy (historic control subjects). When Cox's proportional hazards modeling was applied, the only significant factors for overall survival were recurrent disease, age, and the presence of residual disease. For disease-specific survival, recurrent disease was the only significant factor. Primary site on the lower limb had an adverse effect on locoregional control. For distant control, the only significant factor was residual disease. Conclusions: The multivariate analysis suggests chemotherapy has no effect on survival, but because of the wide confidence limits, a chemotherapy effect cannot be excluded. A study of this size is inadequately powered to detect small improvements in survival, and a larger randomized study remains the only way to truly confirm whether chemotherapy improves the results in high-risk MCC. (c) 2006 Elsevier Inc.
Keyword Oncology
Radiology, Nuclear Medicine & Medical Imaging
Merkel Cell Carcinoma
Chemoradiotherapy
Carboplatin
Etoposide
Synchronous Carboplatin/etoposide
Metastatic Disease
Radiation-therapy
Case Series
Management
Radiotherapy
Recurrent
Tumors
Neck
Head
Q-Index Code C1
Q-Index Status Provisional Code
Institutional Status UQ

Document type: Journal Article
Sub-type: Article (original research)
Collections: 2007 Higher Education Research Data Collection
School of Medicine Publications
 
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Created: Wed, 15 Aug 2007, 08:38:45 EST