Selective radiotherapy for the treatment of head and neck Merkel cell carcinoma

Benjamin Lok, Sabrina Khan, Robert Mutter, Jeffrey Liu, Ryan Fields, Melissa Pulitzer, Weiji Shi, Zhigang Zhang, Dennis Kraus, David Pfister, Klaus J. Busam, Isaac Brownell, Nancy Lee

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23 Scopus citations


BACKGROUND. The role of radiotherapy (RT) in the management of Merkel cell carcinoma (MCC) is controversial. The authors of this report evaluated the rates and patterns of failure in a selected group of patients who underwent RT for MCC of the head and neck (HN). METHODS. The records of 145 consecutive patients with MCC of the HN who presented to the authors' institution between 1988 and 2009 were reviewed. Only patients who received RT at the institution were included. The cumulative incidence of locoregional failure (LRF), distant metastatic failure (DMF), disease progression (DP) and disease-specific death (DSD) were estimated with death as a competing risk. RESULTS. Forty-eight patients were identified. The median follow-up was 51 months (range, 6-220 months) for living patients. LRF developed in 5 patients (10%), and those patients had a median time to recurrence of 3 months. Two of the 5 LRFs were local and developed at the edge of the treatment field; the remaining 3 LRFs were in lymph nodes and occurred outside the treatment field. DMF developed in 12 patients (25%). The estimated 5-year cumulative incidences of LRF, DP, and DSD were 10%, 30%, and 21%, respectively. Acute toxicities included 5 episodes (10%) of grade 3 dermatitis and 1 episode (2%) of grade 3 mucositis. CONCLUSIONS. The authors report a site-specific series of patients with HN MCC who received RT. In this group of patients with adverse features, RT was well tolerated, and LRF was low. The propensity for MCC to recur at the edge of the treatment field suggests that generous margins are appropriate when RT is administered. Cancer 2012. © 2011 American Cancer Society. Adjuvant radiotherapy may benefit patients with Merkel cell carcinoma, which is a rare aggressive neuroendocrine tumor of the skin that is prone to high rates of locoregional failure and systemic progression. The authors report a site-specific series of head and neck Merkel cell carcinoma patients who received radiotherapy and observe that radiation is well tolerated and the rate of locoregional recurrence is low.

Original languageEnglish
Pages (from-to)3937-3944
Number of pages8
Issue number16
StatePublished - Aug 15 2012


  • Merkel cell
  • carcinoma
  • head and neck
  • neuroendocrine
  • radiation
  • radiotherapy
  • recurrence
  • survival


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