Adjuvant chemotherapy for merkel cell cancer.Merkel cell cancer Merkel cell cancer, also called Merkel cell carcinoma, trabecular cancer, Apudoma of skin, or Small cell neuroepithelial tumor of the skin, is a rare and highly aggressive cancer where malignant cancer cells develop on or just beneath the skin and in (MCC (The Microelectronics and Computer Technology Corporation, Austin, TX) The first high-tech research and development consortium in the U.S., created in 1982 by leading companies within the electronics industry. ) is an aggressive cutaneous cutaneous /cu·ta·ne·ous/ (ku-ta´ne-us) pertaining to the skin. cu·ta·ne·ous adj. Of, relating to, or affecting the skin. Cutaneous Pertaining to the skin. malignancy. Despite therapy, more than half of patients relapse and die of metastatic disease. There is currently no consensus on the optimum management for early stage MCC, particularly regarding the role of postsurgical adjuvant treatment. Most guidelines recommend wide excision of the primary tumor in combination with adjuvant radiation. The use of chemotherapy in MCC appears promising given its effect on other neuroendocrine neuroendocrine /neu·ro·en·do·crine/ (-en´do-krin) pertaining to neural and endocrine influence, and particularly to the interaction between the nervous and endocrine systems. neu·ro·en·do·crine adj. carcinomas. Numerous case reports describe the chemosensitivity of MCC, particularly in regional nodal Having to do with nodes. See node. NODAL - Interpreted language implemented on Norsk Data's NORD-10 computers. Used by CERN and DESY high energy physics labs to control their accelerator hardware, PADAC and SEDAC. Included trackball input, graphics. disease. This suggests a possible role for adjuvant chemotherapy in MCC. However, many case series also describe poorer outcomes in patients receiving chemotherapy. These poor outcomes were attributed to the selection of high-risk or recurrent cases requiring aggressive adjuvant therapy. In some reports, response rates of up to 60% were noted, but no long-term improvement in survival was shown. In addition, toxic effects of platinum-based regimens were cited as contributing to decreased long-term response rates. We reviewed the clinical course of 6 patients who received adjuvant chemotherapy after surgical resection and/ or radiation therapy for locally advanced MCC. Four patients received etoposide/platinum (EP) and two received vincristine/doxorubicin/ cyclophosphamide cyclophosphamide /cy·clo·phos·pha·mide/ (-fos´fah-mid) a cytotoxic alkylating agent of the nitrogen mustard group; used as an antineoplastic, as an immunosuppressant to prevent transplant rejection, and to treat some diseases (VAC). The patients who received platinum-based regimens remained relapse-free at 87, 83, 82, and 49 months. One patient who received VAC relapsed 12 months after original presentation, with subsequent resection and radiation. The patient has remained disease free for 77 months. The other patient treated with VAC relapsed at 13 months and died of progressive metastatic disease despite aggressive chemotherapy. Adjuvant chemotherapy is feasible for patients with MCC and a group of patients remains continuously disease-free despite initially locally advanced disease. Prospective studies are needed to determine the extent of effect that adjuvant chemotherapy has on long-term survival. Melissa M. King, MD, and Micheal B. Osswald, MD. Wilford Hall Medical Center, Lackland AFB AFB abbr. acid-fast bacillus AFB Acid-fast bacillus, also 1. Aflatoxin B 2. Aorto-femoral bypass , TX. |
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