title: Palliative treatment for in-transit cutaneous metastases of Merkel cell carcinoma using surface-mold computer-optimized high-dose-rate brachytherapy.
abstract: OBJECTIVE
  The objective of this study was to evaluate the palliative treatment benefit of surface-mold computer-optimized high-dose-rate brachytherapy (SMBT) for in-transit cutaneous metastases of Merkel cell carcinoma (MCC).
  
  
  METHODS
  Ten patients with in-transit cutaneous MCC metastases were treated with SMBT at the Dana-Farber/Brigham & Women's Cancer Center between 2006 and 2012.
  
  
  RESULTS
  The median age at diagnosis was 76 years (range, 63-87 years). Seven patients had in-transit metastases on the lower extremities (70%), 2 patients on the head and neck (20%), and 1 patient on an upper extremity (10%). A total of 152 metastatic MCC lesions were treated with SMBT. All SMBT-treated lesions resolved clinically within a few weeks of therapy. The median follow-up was 34 months (range, 22-85 months). Two of 152 treated lesions recurred during the study period for a local control rate of 99%. Eight patients (80%) developed additional in-transit metastases outside the original SMBT fields. Five of these 8 patients underwent additional SMBT. At study conclusion, 3 patients (30%) are alive without disease, 3 patients (30%) are alive with disease, and 4 patients (40%) died of MCC.
  
  
  CONCLUSIONS
  Surface-mold computer-optimized high-dose-rate brachytherapy offers effective and durable palliation for cutaneous metastases of MCC, although it does not appear to alter disease course.
authors.affiliation: Department of Dermatology, Brigham & Women's Hospital, Harvard Medical School, Boston, MA 21202, USA. lwang@mdmercy.com
authors.forename: Lilit
authors.initials: L
authors.lastname: Garibyan
authors.forename: Shane E
authors.initials: SE
authors.lastname: Cotter
authors.forename: Jorgen L
authors.initials: JL
authors.lastname: Hansen
authors.forename: Claire
authors.initials: C
authors.lastname: Noell
authors.forename: Andrew
authors.initials: A
authors.lastname: Dorosario
authors.forename: Desmond A
authors.initials: DA
authors.lastname: O'Farrell
authors.forename: Phillip M
authors.initials: PM
authors.lastname: Devlin
authors.forename: Linda C
authors.initials: LC
authors.lastname: Wang
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001918:Brachytherapy; D015266:Carcinoma, Merkel Cell / Q000473:pathology / Q000532:radiotherapy* / Q000556:secondary; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009362:Neoplasm Metastasis / Q000473:pathology / Q000532:radiotherapy*; D009364:Neoplasm Recurrence, Local / Q000473:pathology / Q000532:radiotherapy; D010166:Palliative Care; D011379:Prognosis; D011829:Radiation Dosage; D012878:Skin Neoplasms / Q000473:pathology / Q000532:radiotherapy*