Postoperative Radiation Therapy Is Indicated for "Low-Risk" Pathologic Stage I Merkel Cell Carcinoma of the Head and Neck Region but Not for Other Locations.
Postoperative Radiation Therapy Is Indicated for "Low-Risk" Pathologic Stage I Merkel Cell Carcinoma of the Head and Neck Region but Not for Other Locations.
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DOI：
10.1016/j.adro.2023.101364
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发表时间：
2024-02
影响因子：
2.3
通讯作者：
Parvathaneni U
中科院分区：
文献类型：
--
作者：
Bierma MM;Goff PH;Hippe DS;Lachance K;Schaub SK;Wallner K;Tseng YD;Liao JJ;Apisarnthanarax S;Nghiem P;Parvathaneni U
术后放射治疗（PORT）在早期默克尔细胞癌（MCC）中的作用是有争议的。我们分析了PORT在低风险的病理性I期MCC患者中预防局部复发（LR）的作用，基于原发肿瘤的位置：头颈部（HN）与非HN部位。147例MCC患者被确定为“低风险”疾病（病理T1原发肿瘤，镜下边缘阴性，病理淋巴结状态阴性，无免疫抑制或既往全身治疗）。LR定义为肿瘤在原发手术床2 cm以内复发，其发生率采用累积发生率法估算。79例患者接受PORT治疗（30例HN， 49例非HN），中位剂量为50 Gy（范围8-64 Gy）， 68例患者单独接受手术治疗（30例HN， 38例非HN）。总体而言，PORT与LR风险降低相关（5年发生率：0% vs 9.5%; P = 0.004），仅手术组观察到6例LR。尽管PORT的加入显著降低了HN - MCC患者的LR发生率（0% vs. 21%; P = 0.034），但在单纯手术治疗的非HN - MCC患者中未观察到LR。HN组与非HN组相比，无论有无PORT， mcc特异性生存率均无显著差异。对于低风险的病理性I期肢体和躯干MCC，手术获得了良好的局部控制率，不需要PORT。然而，PORT与HN低风险MCC中LRs的显著降低相关。
The role of postoperative radiation therapy (PORT) in early stage Merkel cell carcinoma (MCC) is controversial. We analyzed the role of PORT in preventing local recurrences (LR) among patients with low-risk, pathologic stage I MCC based on the location of the primary tumors: head/neck (HN) versus non-HN sites. One hundred forty-seven patients with MCC were identified that had “low risk” disease (pathologic T1 primary tumor, negative microscopic margins, negative pathologic node status, no immunosuppression or prior systemic therapy). LR was defined as tumor recurrence within 2 cm of the primary surgical bed, and its frequency was estimated with the cumulative incidence method. Seventy-nine patients received PORT (30 HN, 49 non-HN) with a median dose of 50 Gy (range, 8-64 Gy) and 68 patients were treated with surgery alone (30 HN, 38 non-HN). Overall, PORT was associated with a decreased risk of LR (5-year rate: 0% vs 9.5%; P = .004) with 6 LRs observed in the surgery alone group. Although the addition of PORT significantly reduced LR rates among patients with HN MCC (0% vs. 21%; P = .034), no LRs were observed in patients with non-HN MCC managed with surgery alone. There was no significant difference in MCC-specific survival comparing HN versus non-HN groups, with or without PORT. For low-risk, pathologic stage I MCC of the extremities and trunk, excellent local control rates were achieved with surgery, and PORT is not indicated. However, PORT was associated with a significant reduction in LRs among low-risk MCC of the HN.