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

Nora A. Alexander, Stephanie K. Schaub, Peter H. Goff, Daniel S. Hippe, Song Y. Park, Kristina Lachance, Marika Bierma, Jay J. Liao, Smith Apisarnthanarax, Shailender Bhatia, Yolanda D. Tseng, Paul T. Nghiem, Upendra Parvathaneni

Research output: Contribution to journalArticlepeer-review

3 Scopus citations

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. Purpose: We assessed if delays in ttPORT were associated with inferior outcomes. 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. 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). Limitations: The relatively low number of LRRs limited the extent of our multivariable analyses. 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.

Original languageEnglish (US)
Pages (from-to)261-268
Number of pages8
JournalJournal of the American Academy of Dermatology
Volume90
Issue number2
DOIs
StatePublished - Feb 2024
Externally publishedYes

Keywords

  • adjuvant
  • carcinoma
  • dermatologic surgical procedures
  • Merkel Cell
  • patient outcome assessment
  • radiotherapy
  • sentinel lymph node biopsy
  • skin neoplasms
  • wound healing

ASJC Scopus subject areas

  • Dermatology

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