Hostname: page-component-586b7cd67f-dlnhk Total loading time: 0 Render date: 2024-11-29T00:05:38.949Z Has data issue: false hasContentIssue false
  • English
  • Français

Palliative radiotherapy for Merkel cell carcinoma: single-centre experience and review of the literature

Published online by Cambridge University Press:  25 April 2016

Bharthi Kanagaratnam ,
Aadarsh Shah  and
Girija Anand
Bharthi Kanagaratnam*
Affiliation:
Department of Clinical Oncology, North Middlesex University Hospital NHS Trust, London, UK
Aadarsh Shah
Affiliation:
Department of Clinical Oncology, North Middlesex University Hospital NHS Trust, London, UK
Girija Anand
Affiliation:
Department of Clinical Oncology, North Middlesex University Hospital NHS Trust, London, UK
*
Correspondence to: Dr Bharthi Kanagaratnam, Department of Clinical Oncology, North Middlesex University Hospital NHS Trust, Edmonton, London N181QX, UK. Tel: 078 7603 1412. E-mail: [email protected]
Get access Rights & Permissions [Opens in a new window]

Abstract

Background and purpose

Merkel cell carcinoma is a rare and aggressive primary cutaneous neuroendocrine carcinoma with a high risk of loco-regional and distant metastasis. It is predominantly seen in the elderly, on the head and neck or extremities. Although treated primarily with surgery, some patients are too frail. A World Health Organization performance status of two or more with co-existing medical co-morbidities, or the site of the disease adjacent to a critical structure, can prevent surgical management. In this cohort of patients, primary palliative radiotherapy has been found to achieve excellent tumour regression and improve quality of life. A new palliative split-course hypofractionated regime has been used in North Middlesex University Hospital in this cohort of patients. The purpose of this case series was to provide supporting evidence on the efficacy of this dose and fractionation regime and review the literature for the palliative management of Merkel cell carcinoma.

Materials and methods

In total, four patients were treated with the palliative split-course hypofractionated regime. The regime consisted of an initial 20 Gray in 5 fractions over 1 week, a 2-week gap and then a further 20 Gray in 5 fractions over 1 week. Tolerability and response to treatment were evaluated by history and clinical examination.

Results and conclusion

The split-course hypofractionated regime was well tolerated, achieved excellent tumour regression and improved quality of life in all four patients. Since then, a further three patients have been successfully treated with the above regime. This case series demonstrates the efficacy of this dose and fractionation in a select group of patients too frail for radical management and adds to the evidence base for the optimal palliative management of Merkel cell carcinoma.

Keywords

hypofractionationMerkel cell cancerpalliative radiotherapy
Type
Literature Reviews
Information
Journal of Radiotherapy in Practice , Volume 15 , Issue 2 , June 2016 , pp. 189 - 195
Check for updates
Copyright
© Cambridge University Press 2016 

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

1.Toker, C. Trabecular carcinoma of the skin. Arch Dermatol 1972; 105 (1): 107–110.Google Scholar
2.Suarez, C, Rodrigo, J P, Ferlito, A, Devaney, K O, Rinaldo, A. Merkel cell carcinoma of the head and neck. Oral Oncol 2004; 40: 773–779.Google Scholar
3.Poulsen, M. Merkel-cell carcinoma of the skin. Lancet Oncol 2004; 5: 593–599.CrossRefGoogle ScholarPubMed
4.Feng, H, Shuda, M, Chang, Y, Moore, P S. Clonal integration of a polyomavirus human Merkel cell carcinoma. Science 2008; 319 (5866): 1096–1100.Google Scholar
5.National Cancer Intelligence Network. Rare skin Cancer England. http://www.ncin.org.uk. Accessed on 20 October 2015.Google Scholar
6.Hughes, M P, Hardee, M E, Cornelius, L A, Hutchins, L F, Bercker, J C, Gao, L. Merkel cell carcinoma: epidemiology, target, and therapy. Curr Dermatol Rep 2014; 3: 46–53.Google Scholar
7.Edge, S B, Byrd, D R, Compton, C C et al. (eds). Merkel cell carcinoma. AJCC Staging Manual, 7th edition. New York: Springer, 2010: 315–323.Google Scholar
8.Bichakijan, C K, Lowe, L, Lao, C Det al. Merkel cell carcinoma: critical review with guidelines for multidisciplinary management. Cancer 2007; 110 (1): 1–12.CrossRefGoogle Scholar
9.Paulson, K G, Iyer, J G, Byrd, D R, Nghiem, P. Pathologic nodal evaluation is increasingly commonly performed for patients with Merkel cell carcinoma. J Am Acad Dermatol 2013; 69 (4): 653–654.Google Scholar
10.Allen, P J, Bowne, W B, Jaques, D P, Brennan, M F, Busam, K, Coit, D G. Merkel cell carcinoma: prognosis and treatment of patients from a single institution. J Clin Oncol 2005; 23 (10): 2300–2309.Google Scholar
11.Gillenwater, A M, Hessel, A C, Morrison, W Het 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 (2): 149–154.Google Scholar
12.Eng, T Y, Naguib, M, Fuller, C D, Jones, W E 3rd, Herman, T S. Treatment of recurrent Merkel cell carcinoma: an analysis of 46 cases. Am J Clin Oncol 2004; 27 (6): 576–583.Google Scholar
13.Mojica, P, Smith, D, Ellenhorn, J D. Adjuvant radiation therapy is associated with improved survival in Merkel cell carcinoma of the skin. J Clin Oncol 2007; 25 (9): 1043–1047.Google Scholar
14.Lewis, K G, Weinstock, M A, Weaver, A L, Otley, C C. Adjuvant local irradiation for Merkel cell carcinoma. Arch Dermatol 2006; 142 (6): 693–700.CrossRefGoogle ScholarPubMed
15.McAfee, W J, Morris, C G, Mendenhall, C M, Werning, J W, Mendenhall, N P, Mendenhall, W M. Merkel cell carcinoma: treatment and outcomes. Cancer 2005; 104 (8): 1761–1764.Google Scholar
16.Mortier, L, Mirabel, X, Fournier, C, Piette, F, Lartigau, E. Radiotherapy alone for Merkel cell carcinoma. Arch Dermatol 2003; 139 (12): 1587–1590.Google Scholar
17.Koh, C S, Veness, M J. Role of definitive radiotherapy in treating patients with inoperable Merkel cell carcinoma: the Westmead Hospital experience and a review of the literature. Australas J Dermatol 2009; 50: 249–256.Google Scholar
18.Mehrany, K, Otley, C C, Weening, R H, Phillips, P K, Roenigk, R K, Nguyen, T H. A meta-analysis of the prognostic significance of sentinel lymph node status in Merkel cell carcinoma. Dermatol Surg 2002; 28 (2): 113–117.Google ScholarPubMed
19.Veness, M J, Perera, L, McCourt, Jet al. Merkel cell carcinoma: improved outcome with adjuvant radiotherapy. ANZ J Surg 2005; 75 (5): 275–281.Google Scholar
20.Veness, M J, Palme, C E, Morgan, G J. Merkel cell carcinoma: a review of management. Curr Opin Otolaryngol and Head Neck Surg 2008; 16 (2): 170–174.Google Scholar
21.Fang, L C, Lemos, B, Douglas, J, Iyer, J, Nghiem, P. Radiation monotherapy as regional treatment for lymph node-positive Merkel cell carcinoma. Cancer 2010; 116 (7): 1783–1790.CrossRefGoogle ScholarPubMed
22.Poulsen, M G, Rischin, D, Porter, Iet al. Does chemotherapy improve survival in high-risk stage I and II Merkel cell carcinoma of the skin? Int J Radiat Oncol Biol Phys 2006; 64 (1): 114–119.Google Scholar
23.Poulsen, M, Harvey, J. Is there a diminishing role for surgery for Merkel cell carcinoma of the skin? A review of current management. ANZ J Surg 2002; 72: 142–146.Google Scholar
24.Khan, L, Barnes, E A. Radiotherapy for metastatic Merkel cell carcinoma: a review of the literature. J Skin Cancer 2012; 2012: Article ID 654981, 5pp.Google Scholar
25.Pacella, J, Asby, M, Ainslie, J, Minty, C. The role of radiotherapy in the management of primary cutaneous neuroendocrine tumors (Merkel cell or trabecular carcinoma): experience at the Peter MacCallum Cancer Institute (Melbourne, Australia). Int J Radiat Oncol Biol Phys 1988; 14: 1077–1084.CrossRefGoogle Scholar
26.Ashby, M A, Jones, D H, Tasker, A D, Blackshaw, A J. Primary cutaneous neuroendocrine (Merkel cell or trabecular carcinoma) tumour of the skin: a radioresponsive tumour. Clin Radiol 1989; 40: 85–87.CrossRefGoogle ScholarPubMed
27.Brierley, J D, Stockdale, A D, Rostom, A Y. Merkel cell (trabecular) carcinoma of skin treated by radiotherapy. Clin Oncol (R Coll Radiol) 1991; 3: 117–118.CrossRefGoogle ScholarPubMed
28.Kancherla, K N, Oksuz, D C, Prestwich, R Jet al. The role of split-course hypofractionated palliative radiotherapy in the head and neck cancer. Clin Oncol (R Coll Radiol) 2011; 23: 141–148.Google Scholar
29.Oken, M M, Creech, R H, Tormey, D Cet al. Toxicity and response criteria of the Eastern cooperative oncology group. Am J Clin Oncol 1982; 5: 649–655.CrossRefGoogle ScholarPubMed