UKINETS2024 22nd Annual Meeting of the UK and Ireland Neuroendocrine Tumour Society 2024 Poster Presentations (33 abstracts)
Profound, durable benefit from external beam radiotherapy for primary, in transit and locoregional disease from Merkel cell carcinoma in the frail elderly: illustrative clinical vignettes
Elspeth Saunders 1 , Bruce Sizer 2 , Robert Skelly 1 , Jennifer Collins 1 , Srinivasan Gopalakrishnan 2 , Aparna Juneja 1 , Manu Noatay 1 , Carroll Petty 1 , Karen Sheen 2 & Mary McStay 1
1East Suffolk North Essex Foundation Trust, Colchester, United Kingdom. 2East Suffolk North Essex Foundation Trust, Ipswich, United Kingdom
Merkel cell carcinoma (MCC) is a high grade cutaneous neuroendocrine tumour. They are a rare and often aggressive form of skin cancer, with increasing incidence in the elderly. MCC often presents as a firm, red/purple – coloured painless nodule with a short, aggressive history of increasing size. Wide local excision recommends 1-2cm margins, and deep clearance beyond that usually advised for keratinocytic skin cancers, but can have major cosmetic and functional implications especially as up to 50% of lesions are in the Head and Neck area, and elderly patients in particular have comorbidities which may preclude a radical approach requiring reconstructive surgery and prolonged anaesthetics. Radiotherapy is an alternative approach in patients who are not surgical candidates, or in those with advanced, unresectable or metastatic disease. Usually in patients with small tumours, at low risk of recurrence, surgery is considered definitive, but adjuvant post operative irradiation (PORT) may provide additional benefit in terms of risk reduction depending on histopathological features, and improves local control. We present 3 clinical scenarios to illustrate responses to RT: firstly the more typical circumstance of a 78 y/o lady with a 3 month history of enlarging ‘cyst’ on her right cheek, resected in a non-hospital setting, which recurred less than 3 months later, with re-resection showing MCC, but peripheral and deep margins of clearance <0.1mm, given PORT, with remaining disease-free at 9 months. Secondly, an 86-year-old lady with multiple co-morbidities who presented with extensive MCC of right cheek extending from right nasolabial fold, with in transit disease across the whole right cheek, with complete response to RT which remains durable after 8 months’ follow up. Finally, a 96-year-old gentleman presented with MCC right infra-orbital area in 2022, treated with excision but with close margins so received PORT. In 2024 he developed recurrent disease to right parotid and level 1/ 2 neck nodes. Patient received high dose palliative RT with profound response within 2 weeks, which is ongoing. Our patients show that radiotherapy can offer profound responses in elderly patients with MCC, and can achieve durable disease control without risking adverse effects of surgery.
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Endocrine Abstracts
ISSN 1470-3947 (print) | ISSN 1479-6848 (online)
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