Jesse Shulman, Presenter: Nothing to Disclose

Francisco Myslicki, Abstract Co-Author: Nothing to Disclose

Andre Agassi, Abstract Co-Author: Nothing to Disclose

Sharon A. Salenius MPH, Abstract Co-Author: Nothing to Disclose

Daniel E. Dosoretz MD, Abstract Co-Author: Nothing to Disclose

Constantine Mantz, Abstract Co-Author: Nothing to Disclose

Amy Fox, Abstract Co-Author: Nothing to Disclose

Steven Eric Finkelstein MD, Abstract Co-Author: Nothing to Disclose

Eduardo Fernandez-Vicioso MD, PhD, Abstract Co-Author: Nothing to Disclose

Yosef Rotterdam, Abstract Co-Author: Nothing to Disclose

Merkel cell carcinoma (MCC) is an aggressive neuroendocrine cutaneous malignancy that is seen with relative infrequency. There is no optimal standard of care for the treatment MCC. We report on a series of 191 cases to further elucidate the patterns of failure and the current most effective treatment techniques for this disease.

This was a multi-center IRB-approved retrospective review of patients with MCC who underwent surgical excision and adjuvant radiotherapy (RT) between 1994 and 2008. Patients with recurrent or metastatic disease were excluded.

The median age was 76 years, with 89% Caucasian and 73% male. The median follow-up was 29.3 months. A majority of lesions (42%) were located on the head & neck, 31% upper extremity, 13% lower extremity, and 9% torso. Only 14% of patients underwent chemotherapy (CT) consisting of carboplatin/cisplatin and etoposide. Eighty-seven percent underwent wide local excision, 25% a re-excision, 9% Moh’s microsurgery, 40% sentinel lymph node biopsy, and 22% a lymph node dissection. The median overall survival was 38.7 months. Nine percent of patients developed a local recurrence, 12% a nodal recurrence, and 16% distant metastasis. On univariate analysis, RT to the nodal basin was significantly associated with improved survival (median 27.9% vs 44.3%, p=.0422). Patients who presented with a lesion in the torso experienced inferior survival than those who presented with a lesion in other areas (p=.0263). Patients who underwent CT had a median survival of 57% compared to 36% for those who did not undergo CT, although this difference did not reach statistical significance (p=.0711).

Patients who present with merkel cell carcinoma of the extremities or head and neck, and who are treated with RT to the draining nodes experience improved survival compared to those who present with a torso lesion and who do not receive nodal radiation. The role of CT remains unclear.

Radiation therapy following surgical excision and including radiation to the nodal basin can improve survival in patients with localized merkel cell carcinoma.

Shulman, J, Myslicki, F, Agassi, A, Salenius, S, Dosoretz, D, Mantz, C, Fox, A, Finkelstein, S, Fernandez-Vicioso, E, Rotterdam, Y, Multi-Center Long Term Follow-up of Patients Treated for Merkel Cell Carcinoma.  Radiological Society of North America 2014 Scientific Assembly and Annual Meeting, - ,Chicago IL. http://archive.rsna.org/2014/14047426.html