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Postoperative, Single-Fraction Radiation Therapy in Merkel Cell Carcinoma of the Head and Neck.

Authors :
Cook MM
Schaub SK
Goff PH
Fu A
Park SY
Hippe DS
Liao JJ
Apisarnthanarax S
Bhatia S
Tseng YD
Nghiem PT
Parvathaneni U
Source :
Advances in radiation oncology [Adv Radiat Oncol] 2020 Nov-Dec; Vol. 5 (6), pp. 1248-1254. Date of Electronic Publication: 2020 Jul 21.
Publication Year :
2020

Abstract

Purpose: Conventionally fractionated, postoperative radiation therapy (cPORT; 50 Gy in 25 fractions) is considered for patients with Merkel cell carcinoma (MCC) to improve locoregional control. However, cPORT is associated with acute toxicity, especially in the head and neck (H&N) region, and requires daily treatments over several weeks. We previously reported high rates of durable local control with minimal toxicity using 8-Gy single-fraction radiation therapy (SFRT) in the metastatic setting. We report early results on a cohort of patients with localized H&N MCC who received postoperative SFRT if a cPORT regimen was not feasible.<br />Methods and Materials: Twelve patients with localized MCC of the H&N (clinical/pathologic stages I-II) and no prior radiation therapy to the region were identified from an institutional review board-approved prospective registry who underwent surgical resection followed by postoperative SFRT. Time to event was calculated starting from the date of resection before SFRT. The cumulative incidence of in-field locoregional recurrences and out-of-field recurrences was estimated with death as a competing risk.<br />Results: Twelve patients with H&N MCC were identified with clinical/pathologic stages I-II H&N MCC. Median age at diagnosis was 81 years (range, 58-96 years); 25% had immunosuppression. At a median follow-up of 19 months (range, 8-34), there were no in-field locoregional recurrences. A single out-of-field regional recurrence was observed, which was successfully salvaged. There were no MCC-specific deaths. No radiation-associated toxicities greater than grade 1 (Common Terminology Criteria for Adverse Events v5) were observed.<br />Conclusions: Preliminary data suggest that SFRT could offer a potential alternative to cPORT to treat the primary site for localized H&N MCC, particularly in elderly or frail patients, with promising in-field local control and minimal toxicity. Further data with validation in larger cohorts are needed to confirm the sustained safety and efficacy of postoperative SFRT.<br /> (© 2020 The Authors.)

Details

Language :
English
ISSN :
2452-1094
Volume :
5
Issue :
6
Database :
MEDLINE
Journal :
Advances in radiation oncology
Publication Type :
Academic Journal
Accession number :
32838069
Full Text :
https://doi.org/10.1016/j.adro.2020.07.003