Strobel Eva-Susanne, Feyer Petra, Steingräber Maria, Schmitt-Gräff Annette, Kohl Peter Karl
Department of Medical Oncology, St Georg Vorsorge- und Rehabilitationskliniken, Kurhausplatz 1, 79862 Höchenschwand, Germany.
J Cancer Res Clin Oncol. 2008 Feb;134(2):119-23. doi: 10.1007/s00432-007-0257-2. Epub 2007 Jul 25.
Merkel cell carcinoma (MCC) is a rare aggressive neuroendocrine tumor of the skin mainly found in elderly white patients. Due to its poor prognosis with distant metastases in up to 33% and local recurrence in 25-33% and a 5 year disease-specific survival of 64% (1-2) its early diagnosis and appropriate treatment is mandatory.
The study is an exceptional clinical case of a patient with a large inoperable MCC unable to be treated according to treatment guidelines due to her old age. We review the literature addressing treatment options.
The patient was treated with palliative definitive radiotherapy to her large MCC of the left lower leg. She showed a rapid clinical response to four palliative radiation doses of 7 Gy each, necrosis of tumor mass and persistent clearing at a follow-up of 32 weeks. Our patient was very unusual in terms of her extensive MCC and her rapid and complete response to palliative radiotherapy lasting for 6 months at present.
As MCC is an aggressive tumor, best survival is achieved with early diagnosis in a localized stage and prompt adequate surgery and further stage-adjusted treatment. Thus, the differential diagnosis of MCC should not be dismissed in a reddish nodule on the leg, and every excision should be submitted to pathology. In accordance with the literature we demonstrate here that definitive radiotherapy is an effective treatment option for inoperable MCC, which in this individual patient produced necrosis of the extensive tumor mass after only four palliative doses.
默克尔细胞癌（MCC）是一种罕见的侵袭性皮肤神经内分泌肿瘤，主要见于老年白人患者。由于其预后较差，远处转移率高达33%，局部复发率为25%-33%，疾病特异性5年生存率为64%（1-2），因此早期诊断和适当治疗至关重要。
本研究是一例特殊的临床病例，患者为一名患有无法手术切除的大型MCC的患者，因其年龄较大无法按照治疗指南进行治疗。我们回顾了有关治疗选择的文献。
该患者接受了针对左小腿大型MCC的姑息性根治性放疗。她对每次7 Gy的四剂姑息性放疗表现出快速的临床反应，肿瘤肿块坏死，在32周的随访中持续消退。我们的患者在广泛的MCC方面非常不寻常，并且她对目前持续6个月的姑息性放疗反应迅速且完全。
由于MCC是一种侵袭性肿瘤，在局部阶段早期诊断并及时进行充分的手术及进一步的分期调整治疗可实现最佳生存。因此，对于腿部的红色结节不应忽视MCC的鉴别诊断，每次切除都应送病理检查。根据文献，我们在此证明根治性放疗是无法手术切除的MCC的一种有效治疗选择，在该个体患者中，仅四剂姑息性放疗后就使广泛的肿瘤肿块发生了坏死。
