title: Benefits of combined modality treatment of Merkel cell carcinoma of the head and neck: single institution experience.
abstract: BACKGROUND
  There is ongoing debate surrounding the roles of surgery and adjuvant radiotherapy in the management of primary and recurrent Merkel cell carcinoma of the head and neck. This study assessed the influence of local excision, margin status, adjuvant radiotherapy and chemotherapy on locoregional recurrence and survival.
  
  
  METHODS
  A retrospective review of 54 consecutive cases of head and neck Merkel cell carcinoma at a single institution.
  
  
  RESULTS
  Median disease-specific survival time was 120 months. Forty-four per cent of patients developed locoregional recurrence. Combined treatment with surgery and locoregional radiotherapy improved diseasespecific survival. Radiotherapy was associated with longer time to recurrence and regional recurrence. Irradiation of the regional nodes improved regional control, irrespective of clinical status. Margin-negative excision was not associated with improved local control. Combined modality treatment of recurrent disease resulted in a four-fold improvement of local control, but small numbers prevented this trend from reaching statistical significance.
  
  
  CONCLUSIONS
  Surgical excision of the primary disease and clinically involved regional nodes, plus adjuvant radiotherapy to the surgical bed and regional nodes are recommended for all patients with Merkel cell carcinoma of the head and neck, irrespective of clinical status. Recurrent disease should be aggressively treated with combined modality treatment.
authors: Department of Surgical Oncology, Peter MacCallum Cancer Centre, Melbourne, Australia.
authors: V
authors: V
authors: Balakrishnan
authors: S
authors: S
authors: Berry
authors: B
authors: B
authors: Stew
authors: A
authors: A
authors: Sizeland
mesh_terms: D000368:Aged; D015266:Carcinoma, Merkel Cell / Q000532:radiotherapy / Q000601:surgery / Q000628:therapy*; D003131:Combined Modality Therapy; D018572:Disease-Free Survival; D005260:Female; D006258:Head and Neck Neoplasms / Q000532:radiotherapy / Q000601:surgery / Q000628:therapy*; D006801:Humans; D008297:Male; D009364:Neoplasm Recurrence, Local / Q000532:radiotherapy / Q000601:surgery; D018714:Radiotherapy, Adjuvant; D012189:Retrospective Studies; D012878:Skin Neoplasms / Q000532:radiotherapy / Q000601:surgery / Q000628:therapy*; D016896:Treatment Outcome