Single-fraction radiation therapy in patients with metastatic Merkel cell carcinoma

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Abstract:
Merkel cell carcinoma (MCC) is an aggressive, polyomavirus-associated cancer with limited therapeutic options for metastatic disease. Cytotoxic chemotherapy is associated with high response rates, but responses are seldom durable and toxicity is considerable. Here, we report our experience with palliative single-fraction radiotherapy (SFRT) in patients with metastatic MCC. We conducted retrospective analyses of safety and efficacy outcomes in patients that received SFRT (8 Gy) to MCC metastases between 2010 and 2013. Twenty-six patients were treated with SFRT to 93 MCC tumors located in diverse sites that included skin, lymph nodes, and visceral organs. Objective responses were observed in 94% of the measurable irradiated tumors (86/92). Complete responses were observed in 45% of tumors (including bulky tumors up to 16 cm). “In field” lesion control was durable with no progression in 77% (69/89) of treated tumors during median follow-up of 277 days among 16 living patients. Clinically significant toxicity was seen in only two patients who had transient side effects. An exploratory analysis suggested a higher rate of in-field progression in patients with an immunosuppressive comorbidity or prior recent chemotherapy versus those without (30% and 9%, respectively;P = 0.03). Use of SFRT in palliating MCC patients was associated with an excellent in field control rate and durable responses at treated sites, and with minimal toxicity. SFRT may represent a convenient and appealing alternative to systemic chemotherapy for palliation, for which most patients with oligometastatic MCC are eligible. SFRT may also synergize with emerging systemic immune stimulants by lowering tumor burden and enhancing presentation of viral/tumor antigens.

Keywords:
Merkel cell carcinoma; Merkel cell polyomavirus; single-fraction radiation therapy; skin cancer

Autoři: Jayasri G. Iyer ¹; †; Upendra Parvathaneni ²; †; Ted Gooley ³; Natalie J. Miller ¹; Elan Markowitz ³; Astrid Blom ¹; Christopher W. Lewis ¹; Ryan F. Doumani ¹; Kaushik Parvathaneni ¹; Austin Anderson ¹; Amy Bestick ¹; Jay Liao ²; Gabrielle Kane ²; Shailender Bhatia ^3,4,5; Kelly Paulson ¹; Paul Nghiem ^1,3,4,*
Působiště autorů: Department of Medicine/Dermatology, University of Washington, Seattle, Washington ¹; Department of Radiation Oncology, University of Washington, Seattle, Washington ²; Fred Hutchinson Cancer Research Center, Seattle, Washington ³; Seattle Cancer Care Alliance, Seattle, Washington ⁴; Department of Medicine/Oncology, University of Washington, Seattle, Washington †These authors contributed equally to this work. ⁵
Vyšlo v časopise: Cancer Medicine 2015; 4(8)
Kategorie: Original Research
prolekare.web.journal.doi_sk: https://doi.org/10.1002/cam4.458

© 2015 The Authors. Cancer Medicine published by John Wiley & Sons Ltd.
This is an open access article under the terms of the Creative Commons Attribution License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited.
© 2015 The Authors. Cancer Medicine published by John Wiley & Sons Ltd.

Souhrn

Keywords:
Merkel cell carcinoma; Merkel cell polyomavirus; single-fraction radiation therapy; skin cancer

Zdroje

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