title: Chemotherapy compliance in high-risk Merkel cell carcinoma treated with chemoradiotherapy.
abstract: OBJECTIVE
  To evaluate chemotherapy (CT) compliance in patients treated with chemoradiotherapy (CRT) for high-risk Merkel cell cancer (MCC).
  
  
  METHODS
  Data from three prospective clinical trials in high-risk MCC performed by the Trans-Tasman Radiation Oncology Group were included in this analysis. Patients were treated with one of two carboplatin-based CT schedules and standardised radiotherapy (RT) to the primary site and nodes to a dose of 50-60 Gy in 25-30 fractions. Patients' baseline characteristics were analysed using χ2tests to determine compliance factors for completing CT. A Cox univariate analysis was performed to assess the impact of CT compliance on time to locoregional failure, time-to-distant failure, time-to-recurrence and time-to-death.
  
  
  RESULTS
  A total of 88 patients were identified, with a median follow up of 38.5 months. Of these, 75 (85%) completed CT (median age 64.2 years, range 62.0-66.4), while 13 did not (median age 72 years, range 68.1-75.9), P = 0.006. Women comprised 18/75 patients who completed CT and 7/13 patients who did not complete it (P = 0.03). Performance status, site, stage, surgical margins, RT dose and toxicity did not impact on their CT compliance. At 5 years, 26% of patients had locoregional relapse, 26% had distant failure and 34% had died.
  
  
  CONCLUSIONS
  In this small cohort of patients treated with CRT for high-risk MCC, older age and female sex were associated with failure to complete CT. Severe acute skin and haematological toxicity did not correlate with failure to complete CT.
authors.affiliation: Radiation Oncology Centres, St Andrew's Toowoomba Hospital, Toowoomba, Australia.
authors.forename: Peter
authors.initials: P
authors.lastname: Gorayski
authors.affiliation: Cancer Care Services, Royal Brisbane and Women's Hospital, Brisbane, Queensland, Australia.
authors.forename: Lee
authors.initials: L
authors.lastname: Tripcony
authors.affiliation: Division of Cancer Services, Princess Alexandra Hospital, University of Queensland, Brisbane, Queensland, Australia.
authors.forename: Michael
authors.initials: M
authors.lastname: Poulsen
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000009:adverse effects / Q000627:therapeutic use*; D016190:Carboplatin / Q000008:administration & dosage; D015266:Carcinoma, Merkel Cell / Q000556:secondary / Q000628:therapy*; D059248:Chemoradiotherapy; D005260:Female; D006801:Humans; D008207:Lymphatic Metastasis; D008297:Male; D055118:Medication Adherence; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local; D012878:Skin Neoplasms / Q000473:pathology / Q000628:therapy*; D015996:Survival Rate
chemical_list: D016190:Carboplatin
keywords: Merkel cell carcinoma; chemoradiotherapy; compliance; skin