Harrington Chris, Kwan Winkle
Department of Oncology, Christchurch Hospital, Christchurch, New Zealand,
Ann Surg Oncol. 2014 Oct;21(11):3401-5. doi: 10.1245/s10434-014-3757-8. Epub 2014 Jul 8.
Achieving clear surgical margins in Merkel cell carcinoma (MCC) can be difficult due to tumor location or patient comorbidity. Clinical impression suggests that radiation treatment achieves good control of macroscopic disease.
A retrospective chart review was undertaken of all patients with pathological evidence of MCC and treated with curative intent at the BC Cancer Agency between 1979 and 2007. This is a report on the outcomes of those with gross disease treated with radiotherapy, without radical surgery.
Fifty-seven patients received definitive radiotherapy to the primary and/or nodal disease. Median age was 75 years and median follow-up was 34 months (84.5 months for those alive at last follow-up). American Joint Committee on Cancer (AJCC) stage distribution was 23, 19, and 58 % for stages I, II, and III, respectively. Tumor control at sites treated for macroscopic disease was 88 % at 12 months and 82 % at 2 years, and 5-year local relapse-free survival (RFS) was 90 %. Five-year RFS, cancer-specific survival (CSS), and overall survival were 57, 68, and 39 %, respectively. On univariate and multivariate analyses, only male sex was associated with a worse RFS, and a radiotherapy dose >50 Gy was associated with a better CSS.
The retrospective nature of the study and small sample size limit the strength of the conclusions.
Radical radiotherapy is effective in the curative treatment of MCC, especially in patients who would tolerate wide surgical excision poorly, or where it would cause significant cosmetic or functional deficits.
由于肿瘤位置或患者合并症，在默克尔细胞癌（MCC）中实现切缘阴性可能具有挑战性。临床观察表明，放射治疗能很好地控制肉眼可见的疾病。
对1979年至2007年间在不列颠哥伦比亚癌症机构接受根治性治疗且有MCC病理证据的所有患者进行回顾性病历审查。这是一份关于那些接受放疗而非根治性手术治疗的肉眼可见疾病患者的结果报告。
57例患者接受了针对原发灶和/或区域淋巴结疾病的根治性放疗。中位年龄为75岁，中位随访时间为34个月（末次随访时存活患者为84.5个月）。美国癌症联合委员会（AJCC）分期分布为：I期占23%，II期占19%，III期占58%。肉眼可见疾病治疗部位的肿瘤控制率在12个月时为88%，2年时为82%，5年局部无复发生存率（RFS）为90%。5年RFS、癌症特异性生存率（CSS）和总生存率分别为57%、68%和39%。单因素和多因素分析显示，仅男性性别与较差的RFS相关，放疗剂量>50 Gy与较好的CSS相关。
研究的回顾性性质和小样本量限制了结论的说服力。
根治性放疗对MCC的治疗有效，尤其适用于难以耐受广泛手术切除或手术会导致明显美容或功能缺陷的患者。
