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Increased risk of recurrence and disease-specific death following delayed postoperative radiation for Merkel cell carcinoma.

Authors :
Alexander NA
Schaub SK
Goff PH
Hippe DS
Park SY
Lachance K
Bierma M
Liao JJ
Apisarnthanarax S
Bhatia S
Tseng YD
Nghiem PT
Parvathaneni U
Source :
Journal of the American Academy of Dermatology [J Am Acad Dermatol] 2024 Feb; Vol. 90 (2), pp. 261-268. Date of Electronic Publication: 2023 Sep 30.
Publication Year :
2024

Abstract

Background: Merkel cell carcinoma (MCC) is often treated with surgery and postoperative radiation therapy (PORT). The optimal time to initiate PORT (Time-to-PORT [ttPORT]) is unknown.<br />Purpose: We assessed if delays in ttPORT were associated with inferior outcomes.<br />Methods: Competing risk regression was used to evaluate associations between ttPORT and locoregional recurrence (LRR) for patients with stage I/II MCC in a prospective registry and adjust for covariates. Distant metastasis and death were competing risks.<br />Results: The cohort included 124 patients with median ttPORT of 41 days (range: 8-125 days). Median follow-up was 55 months. 17 (14%) patients experienced a LRR, 14 (82%) of which arose outside the radiation field. LRR at 5 years was increased for ttPORT >8 weeks vs ≤ 8 weeks, 28.0% vs 9.2%, P = .006. There was an increase in the cumulative incidence of MCC-specific death with increasing ttPORT (HR = 1.14 per 1-week increase, P = .016).<br />Limitations: The relatively low number of LRRs limited the extent of our multivariable analyses.<br />Conclusions: Delay of PORT was associated with increased LRR, usually beyond the radiation field. This is consistent with the tendency of MCC to spread quickly via lymphatics. Initiation of PORT within 8 weeks was associated with improved locoregional control and MCC-specific survival.<br />Competing Interests: Conflict of interest None disclosed.<br /> (Copyright © 2023 American Academy of Dermatology, Inc. Published by Elsevier Inc. All rights reserved.)

Details

Language :
English
ISSN :
1097-6787
Volume :
90
Issue :
2
Database :
MEDLINE
Journal :
Journal of the American Academy of Dermatology
Publication Type :
Academic Journal
Accession number :
37778663
Full Text :
https://doi.org/10.1016/j.jaad.2023.07.1047