title: Impact of total radiotherapy dose on survival for head and neck Merkel cell carcinoma after resection.
abstract: Head and neck Merkel cell carcinoma (MCC) is commonly treated with surgery and adjuvant radiotherapy (RT) for high-risk features. The optimal radiation dose is unknown.
  
  
  
  One thousand six hundred twenty-five eligible patients with head and neck MCC were identified in the National Cancer Data Base (NCDB). Radiation dose was divided into 3 groups: 30 to <50 Gray (Gy), 50-55 Gy, and >55-70 Gy. Cox regression was used to compare overall survival (OS) between groups, accounting for age, sex, stage, surgery type, margin status, comorbidities, and use of chemotherapy.
  
  
  
  With a median follow-up of 33.5 months, 3-year OS was 48.9%, 70.3%, and 58.7% for 30 to <50 Gy, 50-55 Gy, and >55-70 Gy, respectively (P < .001). Compared to 50-55 Gy, doses between 30 to <50 Gy (adjusted hazard ratio [HR] 1.53; 95% confidence interval [CI] 1.17-1.99; P = .002) and >55-70 Gy (adjusted HR 1.21; 95% CI 1.0-1.46; P = .06) were associated with worse survival.
  
  
  
  Adjuvant radiation doses within 50-55 Gy may be optimal for head and neck MCC.
authors.affiliation: Harvard Radiation Oncology Program, Boston, Massachusetts.
authors.forename: Sagar A
authors.initials: SA
authors.lastname: Patel
authors.affiliation: Department of Radiation Oncology, Boston Medical Center, Boston University School of Medicine, Boston, Massachusetts.
authors.forename: Muhammad M
authors.initials: MM
authors.lastname: Qureshi
authors.affiliation: Department of Radiation Oncology, Boston Medical Center, Boston University School of Medicine, Boston, Massachusetts.
authors.forename: Kimberley S
authors.initials: KS
authors.lastname: Mak
authors.affiliation: Department of Dermatology, Boston Medical Center, Boston University School of Medicine, Boston, Massachusetts.
authors.forename: Debjani
authors.initials: D
authors.lastname: Sahni
authors.affiliation: Harvard Radiation Oncology Program, Boston, Massachusetts.
authors.forename: Nicholas J
authors.initials: NJ
authors.lastname: Giacalone
authors.affiliation: Department of Otolaryngology - Head and Neck Surgery, Boston Medical Center, Boston University School of Medicine, Boston, Massachusetts.
authors.forename: Waleed
authors.identifier: 0000-0002-9849-6184
authors.initials: W
authors.lastname: Ezzat
authors.affiliation: Department of Otolaryngology - Head and Neck Surgery, Boston Medical Center, Boston University School of Medicine, Boston, Massachusetts.
authors.forename: Scharukh
authors.initials: S
authors.lastname: Jalisi
authors.affiliation: Department of Radiation Oncology, Boston Medical Center, Boston University School of Medicine, Boston, Massachusetts.
authors.forename: Minh Tam
authors.identifier: 0000-0001-5174-2096
authors.initials: MT
authors.lastname: Truong
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D015266:Carcinoma, Merkel Cell / Q000401:mortality* / Q000473:pathology / Q000532:radiotherapy* / Q000601:surgery; D016208:Databases, Factual; D018572:Disease-Free Survival; D004307:Dose-Response Relationship, Radiation; D005260:Female; D006258:Head and Neck Neoplasms / Q000401:mortality* / Q000473:pathology / Q000532:radiotherapy* / Q000601:surgery; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D016016:Proportional Hazards Models; D011879:Radiotherapy Dosage; D018714:Radiotherapy, Adjuvant; D012189:Retrospective Studies; D012878:Skin Neoplasms / Q000401:mortality / Q000473:pathology / Q000532:radiotherapy* / Q000601:surgery; D016019:Survival Analysis; D016896:Treatment Outcome
keywords: Merkel cell carcinoma; adjuvant therapy; head and neck; radiation dose; radiotherapy