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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: stewb@doctors.org.uk
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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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