Merkel cell cancer medical therapy: Difference between revisions
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==Medical Therapy== | ==Medical Therapy== | ||
*Merkel cell cancer that has metastasized may respond, at least partially, to treatment with chemotherapy and/or radiation. | *[[Merkel cell cancer]] that has metastasized may respond, at least partially, to treatment with chemotherapy and/or radiation. | ||
=== | ===Radiation=== | ||
* | * [[Merkel cell cancer]] is radiosensitive carcinoma. | ||
* Radiation is an alternative treatment and used can be alone in patients with [[merkel cell cancer]] who are not suitable for surgery.<ref name="pmid21641081">{{cite journal |vauthors=Pape E, Rezvoy N, Penel N, Salleron J, Martinot V, Guerreschi P, Dziwniel V, Darras S, Mirabel X, Mortier L |title=Radiotherapy alone for Merkel cell carcinoma: a comparative and retrospective study of 25 patients |journal=J. Am. Acad. Dermatol. |volume=65 |issue=5 |pages=983–90 |date=November 2011 |pmid=21641081 |doi=10.1016/j.jaad.2010.07.043 |url=}}</ref> | * Radiation is an alternative treatment and used can be alone in patients with [[merkel cell cancer]] who are not suitable for surgery.<ref name="pmid21641081">{{cite journal |vauthors=Pape E, Rezvoy N, Penel N, Salleron J, Martinot V, Guerreschi P, Dziwniel V, Darras S, Mirabel X, Mortier L |title=Radiotherapy alone for Merkel cell carcinoma: a comparative and retrospective study of 25 patients |journal=J. Am. Acad. Dermatol. |volume=65 |issue=5 |pages=983–90 |date=November 2011 |pmid=21641081 |doi=10.1016/j.jaad.2010.07.043 |url=}}</ref> | ||
* Radiotherapy has a curative rate of 75 to 85 percent.<ref name="pmid25001091">{{cite journal |vauthors=Harrington C, Kwan W |title=Outcomes of Merkel cell carcinoma treated with radiotherapy without radical surgical excision |journal=Ann. Surg. Oncol. |volume=21 |issue=11 |pages=3401–5 |date=October 2014 |pmid=25001091 |doi=10.1245/s10434-014-3757-8 |url=}}</ref> | * Radiotherapy has a curative rate of 75 to 85 percent.<ref name="pmid25001091">{{cite journal |vauthors=Harrington C, Kwan W |title=Outcomes of Merkel cell carcinoma treated with radiotherapy without radical surgical excision |journal=Ann. Surg. Oncol. |volume=21 |issue=11 |pages=3401–5 |date=October 2014 |pmid=25001091 |doi=10.1245/s10434-014-3757-8 |url=}}</ref> | ||
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*[[Adjuvant]] [[radiotherapy]] is effective in reducing the rate of recurrence and increasing the 5-year survival of patients with [[merkel cell cancer]]. | *[[Adjuvant]] [[radiotherapy]] is effective in reducing the rate of recurrence and increasing the 5-year survival of patients with [[merkel cell cancer]]. | ||
**Preferred dosage: 60 to 66 Gy | **Preferred dosage: 60 to 66 Gy | ||
===Chemotherapy or chemoradiotherapy=== | |||
* Patients with merkel cell carcinoma who are having a metastatic disease may get beneficial results with chemotherapy.<ref name="pmid16125873">{{cite journal |vauthors=Poulsen MG, Rischin D, Porter I, Walpole E, Harvey J, Hamilton C, Keller J, Tripcony L |title=Does chemotherapy improve survival in high-risk stage I and II Merkel cell carcinoma of the skin? |journal=Int. J. Radiat. Oncol. Biol. Phys. |volume=64 |issue=1 |pages=114–9 |date=January 2006 |pmid=16125873 |doi=10.1016/j.ijrobp.2005.04.042 |url=}}</ref> | |||
*Chemotherapy usually does not cure the disease, but it can be effective in shrinking the tumor size if the tumor is either too large to be resectable or is located within in critical or difficult regions. | |||
*Contraindications in using chemotherapy is immunosuppression which is a great concern. | |||
** Preferred regimen (1): Carboplatin 50 mg/kg PO per day q8h (maximum, 500 mg per dose) | |||
** Preferred regimen (2): Etoposide | |||
=== '''Adjuvant immunotherapy''' === | |||
* | |||
==References== | ==References== | ||
Revision as of 00:45, 23 January 2019
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Associate Editor(s)-in-Chief: Ahmad Al Maradni, M.D. [2]
Overview
The predominant therapy for Merkel cell cancer is surgical resection. Adjunctive chemoradiation may also be required in more advanced disease.
Medical Therapy
- Merkel cell cancer that has metastasized may respond, at least partially, to treatment with chemotherapy and/or radiation.
Radiation
- Merkel cell cancer is radiosensitive carcinoma.
- Radiation is an alternative treatment and used can be alone in patients with merkel cell cancer who are not suitable for surgery.[1]
- Radiotherapy has a curative rate of 75 to 85 percent.[2]
- Systemic relapse after radiotherapy is one f the cause of death in patients with merkel cell cancer.[3]
- Adjuvant radiotherapy is effective in reducing the rate of recurrence and increasing the 5-year survival of patients with merkel cell cancer.
- Preferred dosage: 60 to 66 Gy
Chemotherapy or chemoradiotherapy
- Patients with merkel cell carcinoma who are having a metastatic disease may get beneficial results with chemotherapy.[4]
- Chemotherapy usually does not cure the disease, but it can be effective in shrinking the tumor size if the tumor is either too large to be resectable or is located within in critical or difficult regions.
- Contraindications in using chemotherapy is immunosuppression which is a great concern.
- Preferred regimen (1): Carboplatin 50 mg/kg PO per day q8h (maximum, 500 mg per dose)
- Preferred regimen (2): Etoposide
Adjuvant immunotherapy
References
- ↑ Pape E, Rezvoy N, Penel N, Salleron J, Martinot V, Guerreschi P, Dziwniel V, Darras S, Mirabel X, Mortier L (November 2011). "Radiotherapy alone for Merkel cell carcinoma: a comparative and retrospective study of 25 patients". J. Am. Acad. Dermatol. 65 (5): 983–90. doi:10.1016/j.jaad.2010.07.043. PMID 21641081.
- ↑ Harrington C, Kwan W (October 2014). "Outcomes of Merkel cell carcinoma treated with radiotherapy without radical surgical excision". Ann. Surg. Oncol. 21 (11): 3401–5. doi:10.1245/s10434-014-3757-8. PMID 25001091.
- ↑ Veness M, Foote M, Gebski V, Poulsen M (November 2010). "The role of radiotherapy alone in patients with merkel cell carcinoma: reporting the Australian experience of 43 patients". Int. J. Radiat. Oncol. Biol. Phys. 78 (3): 703–9. doi:10.1016/j.ijrobp.2009.08.011. PMID 19939581.
- ↑ Poulsen MG, Rischin D, Porter I, Walpole E, Harvey J, Hamilton C, Keller J, Tripcony L (January 2006). "Does chemotherapy improve survival in high-risk stage I and II Merkel cell carcinoma of the skin?". Int. J. Radiat. Oncol. Biol. Phys. 64 (1): 114–9. doi:10.1016/j.ijrobp.2005.04.042. PMID 16125873.