CHU Lille, Service de Dermatologie, 59000, Lille, France.
Univ. Lille, Inserm, CHU Lille, U1189 - ONCO-THAI - Assisted Laser Therapy and Immunotherapy for Oncology, 59000, Lille, France.
Radiat Oncol. 2021 May 14;16(1):90. doi: 10.1186/s13014-021-01815-4.
Early stage Merkel cell carcinoma (MCC) is a rare and aggressive primary skin cancer. The standard of care for MCC is broad excision and adjuvant external beam radiation therapy (EBRT). However, for some patients, anesthesia is contraindicated, while others run the risk of serious aesthetic sequelae. In such cases, exclusive radiotherapy is an interesting alternative to surgery. Though limited data is available, this study evaluates exclusive radiotherapy for MCC, using data from the largest retrospective study to date.
All patients who were followed in our center between 1989 and 2019 for histologically proven early stage MCC were included in the study. They were treated either by surgery with a 2-cm clear margin followed by adjuvant radiotherapy (RT) or by exclusive RT. Survival rates with adjuvant and exclusive EBRT were analyzed using Cox model and Fine and Gray model depending on the type of survival. p value < 0.05 was considered significant.
Eighty-four patients treated for MCC were included. Fifty-three of them (63.1%) were treated by exclusive RT, and 31 (36.9%) had surgical excision followed by adjuvant RT. Local relapse rate was 13.7% (95% CI 8.0-43.7) in the RT monotherapy group (group A) and 25.8% (95% CI 10.3-56.2) in the surgery + RT group (group B) (p = 0.42). No statistical difference was found for nodal relapse (p = 0.81), metastatic relapse (p = 0.10), disease free survival (p = 0.83) or overall survival (p = 0.98).
Our study suggests that exclusive radiotherapy for early Merkel cell carcinoma leads to a similar oncological outcome as combined treatment, with fewer aesthetic sequelae. The approach is interesting for elderly patients with comorbidities or patients for whom surgery would cause significant functional or aesthetic sequelae.
早期 Merkel 细胞癌（MCC）是一种罕见且侵袭性的原发性皮肤癌。MCC 的标准治疗方法是广泛切除和辅助外部束放射治疗（EBRT）。然而，对于一些患者，麻醉是禁忌的，而另一些患者则存在严重的美容后遗症风险。在这种情况下，单独进行放疗是一种替代手术的有趣选择。尽管可用的数据有限，但本研究使用迄今为止最大的回顾性研究的数据评估了单独放疗治疗 MCC 的效果。
本研究纳入了 1989 年至 2019 年间在我们中心接受组织学证实的早期 MCC 治疗的所有患者。他们接受了手术治疗，切除范围为 2cm 以上，然后进行辅助放疗（RT），或者仅接受 RT。使用 Cox 模型和 Fine 和 Gray 模型分析辅助和单独 EBRT 的生存率，具体取决于生存类型。p 值<0.05 被认为具有统计学意义。
本研究共纳入 84 例 MCC 患者。其中 53 例（63.1%）患者接受单独 RT 治疗，31 例（36.9%）患者接受手术切除联合辅助 RT。单独 RT 治疗组（A 组）的局部复发率为 13.7%（95%CI 8.0-43.7），手术加 RT 治疗组（B 组）的局部复发率为 25.8%（95%CI 10.3-56.2）（p=0.42）。两组在淋巴结复发（p=0.81）、远处转移复发（p=0.10）、无病生存率（p=0.83）或总生存率（p=0.98）方面均无统计学差异。
我们的研究表明，单独放疗治疗早期 Merkel 细胞癌可获得与联合治疗相似的肿瘤学结果，且美容后遗症较少。对于有合并症的老年患者或因手术会导致严重功能或美容后遗症的患者，这种方法很有趣。
