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20 Year Review of Merkel Cell Carcinoma from a Single Institution: The Cleveland Clinic Experience
George Collis, MD, Susan Orra, BA, Melissa Piliang, MD, Brian Gastman, MD, Raymond Isakov, MD.
Cleveland Clinic, Cleveland, OH, USA.

PURPOSE:
The aim of this study is to evaluate the treatment and outcomes of Merkel Cell Carcinoma from a single, high-volume institution over the past two decades.
METHODS:
A review of all MCC cases at the Cleveland Clinic over the last 20 years was performed. Primary outcomes were disease-free survival, overall survival and recurrence rates. Multiple treatment modalities were compared, including surgery alone, surgery and radiation(XRT), surgery and chemotherapy(CTX), and surgery and chemoradiation(CRT). Secondary outcomes were comparisons among locations of the primary lesion, subgroup analysis of transplant and systemically immunosuppressed patients, comparison of surgical margins and outcomes among different stages.
RESULTS:
76 patients were included in the study from 1993 through 2013 (33 H&N, 25 Extremity, 14 Trunk, 4 Nodal Mass). The mean follow-up was 40 months. 30 underwent surgery alone, 31 Surgery+XRT, 11 Surgery+CRT, 2 Surgery+CTX, 1 palliative XRT, and 1 palliative CRT. Respectively, disease-free and overall survival were 23 and 34 months for surgery alone, 33 and 61 months for surgery+XRT, and 56 and 65 months for surgery+CRT. The recurrence rate for surgery alone was 41 percent compared to 26 percent for surgery+XRT. The greater the stage and if a patient was immunosuppressed or a transplant patient, then the worse the disease-free and overall survival was.
CONCLUSION:
Multi-modality treatment with surgery and radiation improves survival and decreases locoregional recurrence over either treatment alone.


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