Nathu R M, Mendenhall W M, Parsons J T
Department of Radiation Oncology, University of Florida College of Medicine, Gainesville, USA.
Radiat Oncol Investig. 1998;6(5):233-9. doi: 10.1002/(SICI)1520-6823(1998)6:5<233::AID-ROI5>3.0.CO;2-M.
Merkel cell carcinoma is a rare, aggressive neuroendocrine tumor of the skin with a predisposition for local regional and distant spread. Radiotherapy after wide local excision has improved local control, but distant spread continues to be a significant problem. This is an update of our experience in the treatment of Merkel cell carcinoma at the University of Florida. Of 24 patients who were treated for Merkel cell carcinoma between 1984 and 1996, 18 patients were treated at the time of the initial diagnosis, and six were treated after local-regional recurrence. Of the 18 previously untreated patients, 13 had primary sites in the head and neck region, and five had primary sites elsewhere. Minimum follow-up was 1 year; no patient was lost to follow-up. The 5-year absolute survival, cause-specific survival, and local-regional control rates for the entire group were 27%, 31%, and 78%, respectively. Patients who were treated with radiotherapy at the time of initial presentation had 5-year absolute survival, cause-specific survival, and local-regional control rates of 38%, 44%, and 73%, respectively. Most deaths were due to distant metastasis. Site of the primary tumor (head and neck versus other) was not associated with any difference in the outcome. Of six patients who were treated at the time of local-regional recurrence, five developed distant metastasis at 3-19 months (median 8 months) from the time of treatment. One patient was alive and without evidence of disease 13 months after treatment. All patients who were treated at the time of local-regional recurrence had local-regional control after radiotherapy at 3-30 months (median 8 months). Wide local excision and radiotherapy is effective local-regional treatment for Merkel cell carcinoma of the skin, but distant metastasis remains a significant problem in this disease. The role and effectiveness of chemotherapy as part of the initial treatment remains to be defined.
默克尔细胞癌是一种罕见的、侵袭性皮肤神经内分泌肿瘤，易于局部区域和远处转移。广泛局部切除术后放疗改善了局部控制，但远处转移仍然是一个重大问题。这是我们在佛罗里达大学治疗默克尔细胞癌的经验更新。1984年至1996年间接受默克尔细胞癌治疗的24例患者中，18例在初始诊断时接受治疗，6例在局部区域复发后接受治疗。在18例先前未治疗的患者中，13例原发部位在头颈部区域，5例原发部位在其他部位。最短随访时间为1年；无患者失访。整个组的5年绝对生存率、病因特异性生存率和局部区域控制率分别为27%、31%和78%。初始就诊时接受放疗的患者5年绝对生存率、病因特异性生存率和局部区域控制率分别为38%、44%和73%。大多数死亡是由于远处转移。原发肿瘤部位（头颈部与其他部位）与结局的任何差异均无关。在局部区域复发时接受治疗的6例患者中，5例在治疗后3至19个月（中位8个月）发生远处转移。一名患者在治疗后13个月存活且无疾病证据。所有在局部区域复发时接受治疗的患者在放疗后3至30个月（中位8个月）实现了局部区域控制。广泛局部切除和放疗是皮肤默克尔细胞癌有效的局部区域治疗方法，但远处转移仍然是该疾病的一个重大问题。化疗作为初始治疗一部分的作用和有效性仍有待确定。
