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. 2016 Oct 20;1(4):244-251.
doi: 10.1016/j.adro.2016.10.003. eCollection 2016 Oct-Dec.

Postoperative radiation therapy is associated with a reduced risk of local recurrence among low risk Merkel cell carcinomas of the head and neck

Seesha R Takagishi  1 , Tessa E Marx  1 , Christopher Lewis  1 , Erica S Tarabadkar  1 , Ilsa D Juhlin  1 , Astrid Blom  1 , Jayasri G Iyer  1 , Jay J Liao  2 , Yolanda D Tseng  2 , Teresa Fu  3 , Paul Nghiem  1 , Upendra Parvathaneni  2
Affiliations

Postoperative radiation therapy is associated with a reduced risk of local recurrence among low risk Merkel cell carcinomas of the head and neck

Seesha R Takagishi et al. Adv Radiat Oncol. .

Abstract

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.

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Figures

Figure 1
Figure 1
Identification of 46 patients with low-risk Merkel cell carcinoma of the head and neck.
Figure 2
Figure 2
Probability of local recurrence is illustrated for 46 patients who were treated with surgery with or without PORT. Six patients recurred locally in the surgery-alone group, and none recurred locally among the patients treated with surgery + PORT group. The Kaplan-Meier 5-year estimate for local recurrence was 26.3% in the group of patients who were treated with surgery alone. There was a significant difference in local recurrence between patients who did and did not receive postoperative radiation therapy (P = .02).
Figure 3
Figure 3
Cumulative incidence of Merkel cell carcinoma-specific death (MCCSD) is illustrated for 46 patients with low-risk disease. Death as a result of non-MCC causes was used as a competing risk. One patient in each group died as a result of MCC. There was no significant difference in MCCSD between patients who did and did not receive postoperative radiation therapy (P = .88).
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