This article is more than 5 years old. Information may no longer be current.
Adjuvant chemoradiotherapy may improve survival in head and neck Merkel cell carcinoma
Click Here to Manage Email Alerts
Postoperative chemoradiotherapy may be associated with improved OS among patients with Merkel cell carcinoma, suggesting the approach could be an important management tool for this high-risk population.
Head and neck Merkel cell carcinoma is a rare and aggressive form of cancer, incidence of which increased threefold from 1986 to 2001, according to the study background.
There are a broad range of practices for the management of Merkel cell carcinoma, including wide local excision, Mohs’ surgery, sentinel lymph node biopsy, elective or therapeutic neck dissection, radiation therapy, chemotherapy and chemoradiotherapy.
The concept of concurrent radiation therapy and chemotherapy postoperatively is somewhat controversial, according to researchers.
Benjamin L. Judson, MD, assistant professor of surgery (otolaryngology) and associate residency program director for otolaryngology in the department of surgery at Yale University School of Medicine, and colleagues evaluated the association between chemoradiotherapy and OS in patients with head and neck Merkel cell carcinoma.
Judson and colleagues used data from the National Cancer Data Base to identify 4,815 adult patients between 1998 and 2011. The majority of the population was male (62.9%) and white (98.1%).
In the cohort, 92% underwent surgical excision and the remaining 8% underwent Mohs’ surgery.
Negative margins were present in 79.1% of the patients.
The 5-year OS rate was 41.3%, the mean survival time was 5.5 years and the median survival time was 3.41 years.
Adjuvant therapy was administered to 58.6% of the patients. A majority of the patients received postoperative radiation therapy (82.6%). The remaining patients underwent either adjuvant chemoradiotherapy (13.9%) or adjuvant chemotherapy (3.4%).
Five-year OS rates for patients were 47.5% for those who underwent adjuvant chemoradiotherapy, 42.8% for those who underwent adjuvant radiation therapy, 38.5% for those who underwent surgery alone with no adjuvant therapy, and 28.7% for those who underwent adjuvant chemotherapy.
Surgery combined with adjuvant radiation therapy (HR=0.8; 95% CI, 0.7-0.92) or adjuvant chemoradiotherapy (HR=0.62; 95% CI, 0.47-0.81) were associated with better prognosis than surgery alone; however, adjuvant chemotherapy was associated with shorter OS (HR=1.74; 95% CI, 1.1-2.75) when compared with surgery alone.
A secondary analysis of 457 high-risk patients with positive margins who received postoperative therapy showed improved survival with chemoradiotherapy compared with radiation therapy (HR=0.48; 95% CI, 0.25-0.93).
Postoperative chemoradiotherapy also was associated with improved survival in patients with tumors measuring 3 cm or larger (HR=0.52; 95% CI, 0.3-0.9) and in male patients (HR=0.69; 95% CI, 0.5-0.94).
“Although prior studies have not shown an added survival benefit associated with postoperative chemoradiotherapy over radiation therapy, our results suggest that postoperative chemoradiotherapy may be an important tool to use in the management of high-risk patients with head and neck Merkel cell carcinoma,” Judson and colleagues wrote. “Further multi-institutional studies are needed to investigate possible systemic treatments and treatment intensification in order to improve outcomes in head and neck Merkel cell carcinoma.”
Disclosure: The researchers report no relevant financial disclosures.
Click Here to Manage Email Alerts