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Open Access Highly Accessed Research

Radiotherapy is associated with significant improvement in local and regional control in Merkel cell carcinoma

Susan H Kang1, Lauren E Haydu2, Robin Yeong Hong Goh1 and Gerald B Fogarty134*

Author Affiliations

1 Faculty of Medicine, University of New South Wales, Botany Street, Sydney, NSW, 2052, Australia

2 Research and Biostatistics, Melanoma Institute Australia, 40 Rocklands Rd, Crows Nest, NSW, 2065, Australia

3 Genesis Cancer Care, St Vincent’s Clinic, 438 Victoria Street, Darlinghurst, NSW, 2010, Australia

4 Radiation Oncology, Mater Hospital, 25 Rocklands Rd, Crows Nest, NSW, 2065, Australia

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Radiation Oncology 2012, 7:171  doi:10.1186/1748-717X-7-171

Published: 17 October 2012

Abstract

Introduction

Merkel cell carcinoma (MCC) is a rare tumour of skin. This study is a retrospective audit of patients with MCC from St Vincent’s and Mater Hospital, Sydney, Australia. The aim of this study was to investigate the influence of radiotherapy (RT) on the local and regional control of MCC lesions and survival of patients with MCC.

Method

The data bases in anatomical pathology, RT and surgery. We searched for patients having a diagnosis of MCC between 1996 and 2007. Patient, tumour and treatment characteristics were collected and analysed. Univariate survival analysis of categorical variables was conducted with the Kaplan-Meier method together with the Log-Rank test for statistical significance. Continuous variables were assessed using the Cox regression method. Multivariate analysis was performed for significant univariate results.

Results

Sixty seven patients were found. Sixty two who were stage I-III and were treated with radical intent were analysed. 68% were male. The median age was 74 years. Forty-two cases (68%) were stage I or II, and 20 cases (32%) were stage III. For the subset of 42 stage I and II patients, those that had RT to their primary site had a 2-year local recurrence free survival of 89% compared with 36% for patients not receiving RT (p<0.001). The cumulative 2-year regional recurrence free survival for patients having adjuvant regional RT was 84% compared with 43% for patients not receiving this treatment (p<0.001). Immune status at initial surgery was a significant predictor for OS and MCCSS. In a multivariate analysis combining macroscopic size (mm) and immune status at initial surgery, only immune status remained a significant predictor of overall survival (HR=2.096, 95% CI: 1.002-4.385, p=0.049).

Conclusions

RT is associated with significant improvement in local and regional control in Merkel cell carcinoma. Immunosuppression is an important factor in overall survival.

Keywords:
Merkel cell carcinoma; Radiotherapy; Immunosuppression