Single-fraction radiation therapy in patients with metastatic Merkel cell carcinoma.
Single-fraction radiation therapy in patients with metastatic Merkel cell carcinoma.
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DOI：
10.1002/cam4.458
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发表时间：
2015-08
期刊：
影响因子：
4
通讯作者：
Nghiem P
中科院分区：
文献类型：
--
作者：
Iyer JG;Parvathaneni U;Gooley T;Miller NJ;Markowitz E;Blom A;Lewis CW;Doumani RF;Parvathaneni K;Anderson A;Bestick A;Liao J;Kane G;Bhatia S;Paulson K;Nghiem P
默克尔细胞癌（MCC）是一种侵袭性多瘤病毒相关的癌症，转移性疾病的治疗选择有限。细胞毒性化疗与高反应率相关，但反应很少持久，毒性相当大。在这里，我们报告了我们在转移性MCC患者中姑息性单次放疗（SFRT）的经验。我们对2010年至2013年间接受SFRT治疗MCC转移的患者的安全性和有效性结果进行了回顾性分析。26例患者接受SFRT治疗，至93例MCC肿瘤位于不同部位，包括皮肤、淋巴结和内脏器官。94%的可测量放射肿瘤（86/92）观察到客观反应。在45%的肿瘤中观察到完全缓解（包括高达16厘米的大块肿瘤）。“现场”病变控制是持久的，77%（69/89）的治疗肿瘤在277天的中位随访期间没有进展。临床显著的毒性仅见于两例有短暂副作用的患者。一项探索性分析表明，与没有免疫抑制合并症或近期化疗的患者相比，有免疫抑制合并症或近期化疗的患者的野内进展率更高（分别为30%和9%，P = 0.03）。在缓解MCC患者中使用SFRT与出色的现场控制率和治疗部位的持久反应有关，并且毒性最小。对于大多数低转移性MCC患者来说，SFRT可能是一种方便且有吸引力的全身化疗缓解方案。SFRT还可能通过降低肿瘤负荷和增强病毒/肿瘤抗原的呈递，与新兴的全身免疫刺激剂协同作用。
Merkel cell carcinoma (MCC) is an aggressive, polyomavirus-associated cancer with limited therapeutic options for metastatic disease. Cytotoxic chemotherapy is associated with high response rates, but responses are seldom durable and toxicity is considerable. Here, we report our experience with palliative single-fraction radiotherapy (SFRT) in patients with metastatic MCC. We conducted retrospective analyses of safety and efficacy outcomes in patients that received SFRT (8 Gy) to MCC metastases between 2010 and 2013. Twenty-six patients were treated with SFRT to 93 MCC tumors located in diverse sites that included skin, lymph nodes, and visceral organs. Objective responses were observed in 94% of the measurable irradiated tumors (86/92). Complete responses were observed in 45% of tumors (including bulky tumors up to 16 cm). “In field” lesion control was durable with no progression in 77% (69/89) of treated tumors during median follow-up of 277 days among 16 living patients. Clinically significant toxicity was seen in only two patients who had transient side effects. An exploratory analysis suggested a higher rate of in-field progression in patients with an immunosuppressive comorbidity or prior recent chemotherapy versus those without (30% and 9%, respectively; P = 0.03). Use of SFRT in palliating MCC patients was associated with an excellent in field control rate and durable responses at treated sites, and with minimal toxicity. SFRT may represent a convenient and appealing alternative to systemic chemotherapy for palliation, for which most patients with oligometastatic MCC are eligible. SFRT may also synergize with emerging systemic immune stimulants by lowering tumor burden and enhancing presentation of viral/tumor antigens.