Balakrishnan V, Berry S, Stew B, Sizeland A
Department of Surgical Oncology, Peter MacCallum Cancer Centre, Melbourne, Australia.
J Laryngol Otol. 2013 Sep;127(9):908-16. doi: 10.1017/S0022215113001862. Epub 2013 Aug 19.
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.
A retrospective review of 54 consecutive cases of head and neck Merkel cell carcinoma at a single institution.
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 diseasespecific 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.
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.
围绕手术和辅助放疗在头颈部原发性和复发性默克尔细胞癌治疗中的作用，一直存在争议。本研究评估了局部切除、切缘状态、辅助放疗和化疗对局部区域复发及生存的影响。
对某单一机构连续收治的54例头颈部默克尔细胞癌病例进行回顾性分析。
疾病特异性生存时间中位数为120个月。44%的患者出现局部区域复发。手术与局部区域放疗联合治疗可提高疾病特异性生存率。放疗与更长的复发时间及区域复发相关。对区域淋巴结进行照射可改善区域控制，无论临床状态如何。切缘阴性切除与局部控制的改善无关。复发性疾病的综合治疗使局部控制提高了四倍，但由于病例数少，这一趋势未达到统计学意义。
对于所有头颈部默克尔细胞癌患者，无论临床状态如何，均建议对原发性疾病及临床受累的区域淋巴结进行手术切除，并对手术床和区域淋巴结进行辅助放疗。复发性疾病应采用综合治疗积极治疗。
