Merkel Cell Carcinoma by Murad Alam Jeremy S. Bordeaux & Siegrid S. Yu

Author:Murad Alam, Jeremy S. Bordeaux & Siegrid S. Yu
Language: eng
Format: epub
Publisher: Springer New York, New York, NY

Treatment of Recurrent Disease

While guidelines regarding the treatment of primary Merkel cell carcinoma remain controversial, even less data is available as to the optimal management of recurrent disease. Because of Merkel cell carcinoma’s aggressive clinical course, it is not uncommon for patients with recurrent disease to partake of all available treatment options, including a combination of surgery, radiation, and chemotherapy [2]. As such, the NCCN Guidelines recommend individualized treatment for those patients presenting with local and regional recurrences. When available, clinical trials may be appropriate for those with disseminated disease. The treatment strategies utilized in 46 patients with recurrent Merkel cell carcinoma were presented in a small retrospective review by Eng et al. Of 25 patients who sought treatment of their disease, seven received local re-excision only, three received locoregional radiation only, one received chemotherapy only, and the remaining patients received a combination of surgery, radiation, and/or chemotherapy. In patients for which surgery was the sole treatment modality, a 57 % overall survival was noted at a median follow-up time after recurrence of 15 months. The authors proposed individualized multimodality therapy for patients presenting with recurrent Merkel cell carcinoma, including comprehensive salvage surgery for locally or nodally recurrent disease, if possible [21]. In another retrospective case series of 36 patients with Merkel cell carcinoma treated between 1984 and 1994 at the Netherlands Cancer Institute and the Heinrich-Heine-University Dusseldorf, 20 (61 %) patients developed locoregional recurrence. Of these, nine patients underwent salvage therapy with surgical resection and adjuvant radiation, with three alive with no evidence of disease, three alive with disease, and three dead from unrelated conditions at last follow-up. Five patients with unresectable recurrences were treated with radiation alone, and of these, three died of metastatic disease, one remains alive without disease at 6.6 years follow-up, and one is lost to follow-up [22]. Given the dearth of studies on recurrent Merkel cell carcinoma, with only small samples in these two retrospective series, it is nearly impossible to formulate an ideal treatment strategy for patients with recurrent disease. As emphasized before, an individualized plan of care is generally devised using a multidisciplinary approach, incorporating a combination of surgery, radiation, and chemotherapy, as deemed appropriate, and in close consultation with the patient.

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