Table 1Comparison of previously published abstract and current manuscript
Abbreviation: CI = confidence interval.
One of the patients not described in the present manuscript was a 46-year-old man with pT2N1bM0R0 MCC of upper extremity who underwent wide excision of the primary tumor and lymphadenectomy at my center. He subsequently received a single fraction of 8 Gy at the author’s institution to his primary tumor site and 2 regional lymph node basins. Two months later he developed an unresectable recurrence in 1 of the treated lymph node basins, which was initially treated with an ineffective course of immunotherapy and subsequent reirradiation, complicated by autoimmune complications and lymphedema, respectively. This narrative provides additional context to the possible sequelae of a treatment regimen that causes “minimal toxicity.”
Finally, it should be noted that the estimated risk of in-field recurrence in this study is 0%, but given the small sample size, the 95% confidence interval of this event is estimated to be 0% to 25% using binomial “exact” methods. Given the short follow-up of the current series, this is unlikely to be statistically different than the cited 26.3% to 31.9% rates of local recurrence noted 3 to 5 years after surgery alone. Moreover, several centers have reported low rates of excised primary tumor recurrence after wide excision alone (without adjuvant RT).4Frohm M.L. Griffith K.A. Harms K.L. et al.Recurrence and survival in patients with Merkel cell carcinoma undergoing surgery without adjuvant radiation therapy to the primary site.,5Fields R.C. Busam K.J. Chou J.F. et al.Recurrence after complete resection and selective use of adjuvant therapy for stage I through III Merkel cell carcinoma. Prospective randomized clinical trials have yet to identify which patients benefit from adjuvant RT to the site of the primary tumor after resection of MCC, thereby making this topic controversial.The authors are congratulated on studying a novel strategy for a rare malignancy, but the current report does not provide substantive evidence that the approach of surgical excision followed by adjuvant single-fraction RT is superior to either “conventional” surgery or RT.6Zager J.S. Messina J.L. Glass L.F. Sondak V.K. Unanswered questions in the management of stage I-III Merkel cell carcinoma.ReferencesCook M.M. Schaub S.K. Goff P.H. et al.Postoperative, single-fraction radiation therapy in Merkle cell carcinoma of the head and neck.
Adv Radiat Oncol. 5: 1248-1254Cook M. Schaub S. Park S. et al.Efficacy and toxicity of hypofractionated adjuvant radiotherapy in Merkel cell carcinoma.
JID. 139: S95Goff P. Cook M. Schaub S. et al.Efficacy and toxicity of hypofractionated adjuvant radiotherapy in Merkle cell carcinoma.
Int J Radiat Oncol Biol Phys. 108: E46Frohm M.L. Griffith K.A. Harms K.L. et al.Recurrence and survival in patients with Merkel cell carcinoma undergoing surgery without adjuvant radiation therapy to the primary site.
JAMA Dermatol. 152: 1001-1007Fields R.C. Busam K.J. Chou J.F. et al.Recurrence after complete resection and selective use of adjuvant therapy for stage I through III Merkel cell carcinoma.
Cancer. 118: 3311-3320Zager J.S. Messina J.L. Glass L.F. Sondak V.K.Unanswered questions in the management of stage I-III Merkel cell carcinoma.
J Natl Compr Canc Netw. 12: 425-431Article InfoPublication HistoryAccepted: January 11, 2021
Received: January 4, 2021
FootnotesSources of support: This study was funded in part by a grant from the National Cancer Institute / National Institutes of Health ( P30-CA008748 ) made to the Memorial Sloan Kettering Cancer Center .
Disclosures: none.
IdentificationDOI: https://doi.org/10.1016/j.adro.2021.100684
Copyright© 2021 The Author. Published by Elsevier Inc. on behalf of American Society for Radiation Oncology.
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