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Benefits of combined modality treatment of Merkel cell carcinoma of the head and neck: single institution experience

Published online by Cambridge University Press:  19 August 2013

V Balakrishnan ,
S Berry ,
B Stew  and
A Sizeland
V Balakrishnan
Affiliation:
Department of Surgical Oncology, Peter MacCallum Cancer Centre, Melbourne, Australia
S Berry
Affiliation:
Department of Otolaryngology, Head and Neck Surgery, Royal Glamorgan Hospital, Llantrisant, Wales, UK
B Stew*
Affiliation:
Department of Otolaryngology, Head and Neck Surgery, Royal Glamorgan Hospital, Llantrisant, Wales, UK
A Sizeland
Affiliation:
Department of Surgical Oncology, Peter MacCallum Cancer Centre, Melbourne, Australia
*
Address for correspondence: Mr B Stew, Department of Otolaryngology, Head and Neck Surgery, Royal Glamorgan Hospital, Llantrisant CF72 8XR, Wales, UK E-mail: [email protected]
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Abstract

Background:

There is ongoing debate surrounding the roles of surgery and adjuvant radiotherapy in the management of primary and recurrent Merkel cell carcinoma of the head and neck. This study assessed the influence of local excision, margin status, adjuvant radiotherapy and chemotherapy on locoregional recurrence and survival.

Method:

A retrospective review of 54 consecutive cases of head and neck Merkel cell carcinoma at a single institution.

Results:

Median disease-specific survival time was 120 months. Forty-four per cent of patients developed locoregional recurrence. Combined treatment with surgery and locoregional radiotherapy improved disease-specific survival. Radiotherapy was associated with longer time to recurrence and regional recurrence. Irradiation of the regional nodes improved regional control, irrespective of clinical status. Margin-negative excision was not associated with improved local control. Combined modality treatment of recurrent disease resulted in a four-fold improvement of local control, but small numbers prevented this trend from reaching statistical significance.

Conclusion:

Surgical excision of the primary disease and clinically involved regional nodes, plus adjuvant radiotherapy to the surgical bed and regional nodes are recommended for all patients with Merkel cell carcinoma of the head and neck, irrespective of clinical status. Recurrent disease should be aggressively treated with combined modality treatment.

Keywords

Merkel Cell TumorCombined Modality TherapySurvival
Type
Main Articles
Information
The Journal of Laryngology & Otology , Volume 127 , Issue 9 , September 2013 , pp. 908 - 916
Copyright
Copyright © JLO (1984) Limited 2013 

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References

1Allen, PJ, Bowne, WB, Jaques, DP, Brennan, MF, Busam, K, Coit, DG. Merkel cell carcinoma: prognosis and treatment of patients from a single institution. J Clin Oncol 2005;23:2300–9CrossRefGoogle ScholarPubMed
2Medina-Franco, H, Urist, MM, Fiveash, J, Heslin, MJ, Bland, KI, Beenken, SW. Multimodality treatment of Merkel cell carcinoma: case series and literature review of 1024 cases. Ann Surg Oncol 2001;8:204–8CrossRefGoogle ScholarPubMed
3Poulsen, M. Merkel-cell carcinoma of the skin. Lancet Oncol 2004;5:593–9CrossRefGoogle ScholarPubMed
4Eng, TY, Boersma, MG, Fuller, CD, Goytia, V, Jones, WE 3rd, Joyner, M et al. A comprehensive review of the treatment of Merkel cell carcinoma. Am J Clin Oncol 2007;30:624–36CrossRefGoogle ScholarPubMed
5Miller, SJ, Alam, M, Andersen, J, Berg, D, Bichakjian, CK, Bowen, G et al. Merkel cell carcinoma. J Natl Compr Canc Netw 2006;4:704–12Google ScholarPubMed
6Allen, PJ, Zhang, ZF, Coit, DG. Surgical management of Merkel cell carcinoma. Ann Surg 1999;229:97–105CrossRefGoogle ScholarPubMed
7Houben, R, Shuda, M, Weinkam, R, Schrama, D, Feng, H, Chang, Y et al. Merkel cell polyomavirus-infected Merkel cell carcinoma cells require expression of viral T antigens. J Virol 2010;84:7064–72CrossRefGoogle ScholarPubMed
8Ott, MJ, Tanabe, KK, Gadd, MA, Stark, P, Smith, BL, Finkelstein, DM et al. Multimodality management of Merkel cell carcinoma. Arch Surg 1999;134:388–92; discussion 392–3CrossRefGoogle ScholarPubMed
9Brissett, AE, Olsen, KD, Kasperbauer, JL, Lewis, JE, Goellner, JR, Spotts, BE et al. Merkel cell carcinoma of the head and neck: a retrospective case series. Head Neck 2002;24:982–8CrossRefGoogle ScholarPubMed
10Clark, JR, Veness, MJ, Gilbert, R, O'Brien, CJ, Gullane, PJ. Merkel cell carcinoma of the head and neck: is adjuvant radiotherapy necessary? Head Neck 2007;29:249–57CrossRefGoogle ScholarPubMed
11Gillenwater, AM, Hessel, AC, Morrison, WH, Burgess, M, Silva, EG, Roberts, D et al. Merkel cell carcinoma of the head and neck: effect of surgical excision and radiation on recurrence and survival. Arch Otolaryngol Head Neck Surg 2001;127:149–54CrossRefGoogle ScholarPubMed
12Lawenda, BD, Arnold, MG, Tokarz, VA, Silverstein, JR, Busse, PM, McIntyre, JF et al. Analysis of radiation therapy for the control of Merkel cell carcinoma of the head and neck based on 36 cases and a literature review. Ear Nose Throat J 2008;87:634–43CrossRefGoogle ScholarPubMed
13Veness, MJ, Morgan, GJ, Gebski, V. Adjuvant locoregional radiotherapy as best practice in patients with Merkel cell carcinoma of the head and neck. Head Neck 2005;27:208–16CrossRefGoogle ScholarPubMed
14Goepfert, H, Remmler, D, Silva, E, Wheeler, B. Merkel cell carcinoma (endocrine carcinoma of the skin) of the head and neck. Arch Otolaryngol 1984;110:707–12CrossRefGoogle ScholarPubMed
15Raaf, JH, Urmacher, C, Knapper, WK, Shiu, MH, Cheng, EW. Trabecular (Merkel cell) carcinoma of the skin. Treatment of primary, recurrent, and metastatic disease. Cancer 1986;57:178–823.0.CO;2-T>CrossRefGoogle ScholarPubMed
16Müller, A, Keus, R, Neumann, N, Lammering, G, Schnabel, T. Management of Merkel cell carcinoma: case series of 36 patients. Oncol Rep 2003;10:577–85Google ScholarPubMed
17McAfee, WJ, Morris, CG, Mendenhall, CM, Werning, JW, Mendenhall, NP, Mendenhall, WM. Merkel cell carcinoma: treatment and outcomes. Cancer 2005;104:1761–4CrossRefGoogle ScholarPubMed
18Meeuwissen, JA, Bourne, RG, Kearsley, JH. The importance of postoperative radiation therapy in the treatment of Merkel cell carcinoma. Int J Radiat Oncol Biol Phys 1995;31:325–31CrossRefGoogle ScholarPubMed
19Jabbour, J, Cumming, R, Scolyer, RA, Hruby, G, Thompson, JF, Lee, S. Merkel cell carcinoma: assessing the effect of wide local excision, lymph node dissection, and radiotherapy on recurrence and survival in early-stage disease–results from a review of 82 consecutive cases diagnosed between 1992 and 2004. Ann Surg Oncol 2007;14:1943–52CrossRefGoogle ScholarPubMed
20Yiengpruksawan, A, Coit, DG, Thaler, HT, Urmacher, C, Knapper, WK. Merkel cell carcinoma. Prognosis and management. Arch Surg 1991;126:1514–19CrossRefGoogle ScholarPubMed
21Bajetta, E, Celio, L, Platania, M, Lo Vullo, S, Patuzzo, R, Maurichi, A et al. Single-institution series of early-stage Merkel cell carcinoma: long-term outcomes in 95 patients managed with surgery alone. Ann Surg Oncol 2009;16:2985–93CrossRefGoogle ScholarPubMed
22Kokoska, ER, Kokoska, MS, Collins, BT, Stapleton, DR, Wade, TP. Early aggressive treatment for Merkel cell carcinoma improves outcome. Am J Surg 1997;174:688–93CrossRefGoogle ScholarPubMed
23Veness, MJ, Perera, L, McCourt, J, Shannon, J, Hughes, TM, Morgan, GJ et al. Merkel cell carcinoma: improved outcome with adjuvant radiotherapy. ANZ J Surg 2005;75:275–81CrossRefGoogle ScholarPubMed
24Hui, AC, Stillie, AL, Seel, M, Ainslie, J. Merkel cell carcinoma: 27-year experience at the Peter MacCallum Cancer Centre. Int J Radiat Oncol Biol Phys 2011;80:1430–5CrossRefGoogle ScholarPubMed
25Lewis, KG, Weinstock, MA, Weaver, AL, Otley, CC. Adjuvant local irradiation for Merkel cell carcinoma. Arch Dermatol 2006;142:693–700CrossRefGoogle ScholarPubMed
26Morrison, WH, Peters, LJ, Silva, EG, Wendt, CD, Ang, KK, Goepfert, H. The essential role of radiation therapy in securing locoregional control of Merkel cell carcinoma. Int J Radiat Oncol Biol Phys 1990;19:583–91CrossRefGoogle ScholarPubMed
27Eich, HT, Eich, D, Staar, S, Mauch, C, Stutzer, H, Groth, W et al. Role of postoperative radiotherapy in the management of Merkel cell carcinoma. Am J Clin Oncol 2002;25:50–6CrossRefGoogle ScholarPubMed
28Foote, M, Harvey, J, Porceddu, S, Dickie, G, Hewitt, S, Colquist, S et al. Effect of radiotherapy dose and volume on relapse in Merkel cell cancer of the skin. Int J Radiat Oncol Biol Phys 2010;77:677–84CrossRefGoogle ScholarPubMed
29Mojica, P, Smith, D, Ellenhorn, JD. Adjuvant radiation therapy is associated with improved survival in Merkel cell carcinoma of the skin. J Clin Oncol 2007;25:1043–7CrossRefGoogle ScholarPubMed
30Hill, AD, Brady, MS, Coit, DG. Intraoperative lymphatic mapping and sentinel lymph node biopsy for Merkel cell carcinoma. Br J Surg 1999;86:518–21CrossRefGoogle ScholarPubMed
31Mehrany, K, Otley, CC, Weenig, RH, Phillips, PK, Roenigk, RK, Nguyen, TH. A meta-analysis of the prognostic significance of sentinel lymph node status in Merkel cell carcinoma. Dermatol Surg 2002;28:113–17Google ScholarPubMed
32Schmalbach, CE, Lowe, L, Teknos, TN, Johnson, TM, Bradford, CR. Reliability of sentinel lymph node biopsy for regional staging of head and neck Merkel cell carcinoma. Arch Otolaryngol Head Neck Surg 2005;131:610–14CrossRefGoogle ScholarPubMed
33Maza, S, Trefzer, U, Hofmann, M, Schneider, S, Voit, C, Krossin, T et al. Impact of sentinel lymph node biopsy in patients with Merkel cell carcinoma: results of a prospective study and review of the literature. Eur J Nucl Med Mol Imaging 2006;33:433–40CrossRefGoogle ScholarPubMed
34Victor, NS, Morton, B, Smith, JW. Merkel cell cancer: is prophylactic lymph node dissection indicated? Am Surg 1996;62:879–82Google ScholarPubMed
35Hitchcock, CL, Bland, KI, Laney, RG 3rd, Franzini, D, Harris, B, Copeland, EM 3rd. Neuroendocrine (Merkel cell) carcinoma of the skin. Its natural history, diagnosis, and treatment. Ann Surg 1988;207:201–7CrossRefGoogle ScholarPubMed
36Shaw, JH, Rumball, E. Merkel cell tumour: clinical behaviour and treatment. Br J Surg 1991;78:138–42CrossRefGoogle ScholarPubMed
37Suntharalingam, M, Rudoltz, MS, Mendenhall, WM, Parsons, JT, Stringer, SP, Million, RR. Radiotherapy for Merkel cell carcinoma of the skin of the head and neck. Head Neck 1995;17:96–101CrossRefGoogle ScholarPubMed
38Veness, MJ, Palme, CE, Morgan, GJ. Merkel cell carcinoma: a review of management. Curr Opin Otolaryngol Head Neck Surg 2008;16:170–4CrossRefGoogle ScholarPubMed
39Fang, LC, Lemos, B, Douglas, J, Iyer, J, Nghiem, P. Radiation monotherapy as regional treatment for lymph node-positive Merkel cell carcinoma. Cancer 2010;116:1783–90CrossRefGoogle ScholarPubMed
40Boyer, JD, Zitelli, JA, Brodland, DG, D'Angelo, G. Local control of primary Merkel cell carcinoma: review of 45 cases treated with Mohs micrographic surgery with and without adjuvant radiation. J Am Acad Dermatol 2002;47:885–92CrossRefGoogle ScholarPubMed
41Tai, PT, Yu, E, Winquist, E, Hammond, A, Stitt, L, Tonita, J et al. Chemotherapy in neuroendocrine/Merkel cell carcinoma of the skin: case series and review of 204 cases. J Clin Oncol 2000;18:2493–9CrossRefGoogle ScholarPubMed
42Tai, P, Yu, E, Assouline, A, Lian, JD, Joseph, K, Miale, T et al. Multimodality management for 145 cases of Merkel cell carcinoma. Med Oncol 2010;27:1260–6CrossRefGoogle ScholarPubMed
43Voog, E, Biron, P, Martin, JP, Blay, JY. Chemotherapy for patients with locally advanced or metastatic Merkel cell carcinoma. Cancer 1999;85:2589–953.0.CO;2-F>CrossRefGoogle ScholarPubMed
44Fenig, E, Brenner, B, Katz, A, Rakovsky, E, Hana, MB, Sulkes, A. The role of radiation therapy and chemotherapy in the treatment of Merkel cell carcinoma. Cancer 1997;80:881–53.0.CO;2-O>CrossRefGoogle ScholarPubMed
45Poulsen, M, Rischin, D, Walpole, E, Harvey, J, Macintosh, J, Ainslie, J et al. Analysis of toxicity of Merkel cell carcinoma of the skin treated with synchronous carboplatin/etoposide and radiation: a Trans-Tasman Radiation Oncology Group study. Int J Radiat Oncol Biol Phys 2001;51:156–63CrossRefGoogle ScholarPubMed
46Gupta, SG, Wang, LC, Peñas, PF, Gellenthin, M, Lee, SJ, Nghiem, P. Sentinel lymph node biopsy for evaluation and treatment of patients with Merkel cell carcinoma: the Dana-Farber experience and meta-analysis of the literature. Arch Dermatol 2006;142:685–90CrossRefGoogle ScholarPubMed
47Stadelmann, WK, Cobbins, L, Lentsch, EJ. Incidence of nonlocalization of sentinel lymph nodes using preoperative lymphoscintigraphy in 74 consecutive head and neck melanoma and Merkel cell carcinoma patients. Ann Plast Surg 2004;52:546–9CrossRefGoogle ScholarPubMed
48Balkissoon, J, Rasgon, BM, Schweitzer, L. Lymphatic mapping for staging of head and neck cancer. Semin Oncol 2004;31:382–93CrossRefGoogle ScholarPubMed
49Alex, JC. The application of sentinel node radiolocalization to solid tumors of the head and neck: a 10-year experience. Laryngoscope 2004;114:2–19CrossRefGoogle Scholar
50Ellis, MC, Weerasinghe, R, Corless, CL, Vetto, JT. Sentinel lymph node staging of cutaneous melanoma: predictors and outcomes. Am J Surg 2010;199:663–8CrossRefGoogle ScholarPubMed