title: Merkel cell carcinoma: assessing the effect of wide local excision, lymph node dissection, and radiotherapy on recurrence and survival in early-stage disease--results from a review of 82 consecutive cases diagnosed between 1992 and 2004.
abstract: BACKGROUND
  Wide surgical excision, lymph node dissection, and radiotherapy have been used with varying efficacy in the management of early-stage Merkel cell carcinoma.
  
  
  METHODS
  Records of 82 patients with early-stage Merkel cell carcinoma between 1992 and 2004 were reviewed.
  
  
  RESULTS
  Forty-two patients developed a recurrence, and 44 died during the study period. Twenty-nine patients presented with regional lymph node disease, which was independently associated with diminished survival (hazard ratio [HR], 4.08; 95% confidence interval [CI], 1.55-10.75; P = .005). Lymphadenectomy was independently associated with prolonged disease-free survival (median, 28.5 vs. 11.8 months; HR, .46; 95% CI, .22-.94; P = .034) but not overall survival (P = .25). Margin-negative excision of the primary tumor (60 of 73) was not significantly associated with either prolonged disease-free survival (median, 16 vs. 14 months) or overall survival (median, 54 vs. 34 months). Forty-eight patients received radiotherapy: 36 to the primary site and 31 to the regional lymph nodes. Radiotherapy to both sites was associated with a longer median time to first recurrence (primary site, 24.2 vs. 11.8 months; regional lymph nodes, 46.2 vs. 11.3 months) and survival (primary site, 53.9 vs. 45.7 months; regional lymph nodes, 103.1 vs. 34.2 months). Administration of any radiotherapy was significantly associated with a prolonged time to first recurrence (HR, .39; 95% CI, .20-.75; P = .004) and survival (HR, .39; 95% CI, .18-.82; P = .013) on the Cox regression multivariate analyses.
  
  
  CONCLUSIONS
  Adjuvant radiotherapy to the primary site after surgical excision is recommended in early-stage disease. Involved regional lymph nodes should be treated with radiotherapy with or without lymphadenectomy.
authors.affiliation: Sydney Cancer Centre, Sydney, Australia. j.jabbour@optusnet.com.au
authors.forename: James
authors.initials: J
authors.lastname: Jabbour
authors.forename: Robert
authors.initials: R
authors.lastname: Cumming
authors.forename: Richard A
authors.initials: RA
authors.lastname: Scolyer
authors.forename: George
authors.initials: G
authors.lastname: Hruby
authors.forename: John F
authors.initials: JF
authors.lastname: Thompson
authors.forename: Stephen
authors.initials: S
authors.lastname: Lee
mesh_terms: D000368:Aged; D015266:Carcinoma, Merkel Cell / Q000532:radiotherapy / Q000556:secondary / Q000601:surgery*; D018572:Disease-Free Survival; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008197:Lymph Node Excision; D008198:Lymph Nodes / Q000528:radiation effects; D008207:Lymphatic Metastasis / Q000473:pathology; D008297:Male; D009364:Neoplasm Recurrence, Local / Q000473:pathology*; D009367:Neoplasm Staging; D018714:Radiotherapy, Adjuvant; D012189:Retrospective Studies; D012878:Skin Neoplasms / Q000532:radiotherapy / Q000601:surgery*; D015996:Survival Rate; D013997:Time Factors