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• W2039698876 abstract "Purpose/Objective(s)The objective of this study was to report the feasibility of sentinel lymph node biopsy (SLNB) in patients with Merkel Cell Carcinoma (MCC) and determine the regional control probability in patients with a negative SLNB.Materials/MethodsFifteen patients with clinical stage I MCC who underwent SLNB at or following wide local excision for MCC (2000 to 2006) at William Beaumont Hospital were identified. Thirteen of 15 patients had intraoperative lymphatic mapping with isosulfane blue dye and 99mTc-labeled sulfur colloid, while 1 patient had 99mTc-labeled sulfur colloid alone. In 1 patient the technique for SLNB was unknown. Routine H&E and immunohistochemistry was utilized to evaluate all SLNs. Thirteen patients received post-operative RT to the surgical bed (median dose, 5000 cGy), while 3 patients also received regional RT (median dose, 5000 cGy). Two patients received sequential chemotherapy in the adjuvant setting. The median potential follow-up time was 3.4 yrs (range, 1.6-7.2 yrs).ResultsThe median age of the cohort at presentation was 76 yrs (range, 48-90 yrs) and the median tumor size was 2.2 cm (range, 0.3-4.7 cm). A SLN was identified in 13 of 15 patients for a success rate of 87%. A total of 21 SLNs were retrieved for a median of 2 SLNs per patient (mean 1.6). For the 2 patients who were unable to be mapped, 1 patient had a limited LN dissection identifying a single negative LN, while no additional LN assessment was performed in the other patient. Three of 13 patients (23%) had evidence of MCC in the SLN specimen, each with one positive LN. Patients with a negative SLNB received radiation to the surgical bed alone. One patient had a recurrence in the surgical bed for a 3yr local control rate of 80%. Two patients with negative SLNB had evidence of regional failure for a 3yr regional control rate of 78%. One patient had a preauricular nodal failure from an H&N primary lesion, while the other presented as an in-transit metastasis in the thigh from a below the knee primary lesion. The 3yr failure rate in the unirradiated nodal region was 10%. Distant metastases developed in 3 patients (3yr DM rate 74%) at a median time from diagnosis of 0.3 yrs. Three patients have died of MCC. Of those with positive SLNs (n = 3), 2 underwent completion lymph node dissection followed by regional nodal irradiation, while 1 patient received regional nodal irradiation alone. No further failures were seen in the regional nodal basin of patients with an initial positive SLN.ConclusionsSLNB can accurately identify regional nodal disease in patients presenting with clinical stage I MCC. Exclusion of regional nodal irradiation in patients with negative SLNB results in appropriate regional control after post-operative irradiation to the surgical bed. Purpose/Objective(s)The objective of this study was to report the feasibility of sentinel lymph node biopsy (SLNB) in patients with Merkel Cell Carcinoma (MCC) and determine the regional control probability in patients with a negative SLNB. The objective of this study was to report the feasibility of sentinel lymph node biopsy (SLNB) in patients with Merkel Cell Carcinoma (MCC) and determine the regional control probability in patients with a negative SLNB. Materials/MethodsFifteen patients with clinical stage I MCC who underwent SLNB at or following wide local excision for MCC (2000 to 2006) at William Beaumont Hospital were identified. Thirteen of 15 patients had intraoperative lymphatic mapping with isosulfane blue dye and 99mTc-labeled sulfur colloid, while 1 patient had 99mTc-labeled sulfur colloid alone. In 1 patient the technique for SLNB was unknown. Routine H&E and immunohistochemistry was utilized to evaluate all SLNs. Thirteen patients received post-operative RT to the surgical bed (median dose, 5000 cGy), while 3 patients also received regional RT (median dose, 5000 cGy). Two patients received sequential chemotherapy in the adjuvant setting. The median potential follow-up time was 3.4 yrs (range, 1.6-7.2 yrs). Fifteen patients with clinical stage I MCC who underwent SLNB at or following wide local excision for MCC (2000 to 2006) at William Beaumont Hospital were identified. Thirteen of 15 patients had intraoperative lymphatic mapping with isosulfane blue dye and 99mTc-labeled sulfur colloid, while 1 patient had 99mTc-labeled sulfur colloid alone. In 1 patient the technique for SLNB was unknown. Routine H&E and immunohistochemistry was utilized to evaluate all SLNs. Thirteen patients received post-operative RT to the surgical bed (median dose, 5000 cGy), while 3 patients also received regional RT (median dose, 5000 cGy). Two patients received sequential chemotherapy in the adjuvant setting. The median potential follow-up time was 3.4 yrs (range, 1.6-7.2 yrs). ResultsThe median age of the cohort at presentation was 76 yrs (range, 48-90 yrs) and the median tumor size was 2.2 cm (range, 0.3-4.7 cm). A SLN was identified in 13 of 15 patients for a success rate of 87%. A total of 21 SLNs were retrieved for a median of 2 SLNs per patient (mean 1.6). For the 2 patients who were unable to be mapped, 1 patient had a limited LN dissection identifying a single negative LN, while no additional LN assessment was performed in the other patient. Three of 13 patients (23%) had evidence of MCC in the SLN specimen, each with one positive LN. Patients with a negative SLNB received radiation to the surgical bed alone. One patient had a recurrence in the surgical bed for a 3yr local control rate of 80%. Two patients with negative SLNB had evidence of regional failure for a 3yr regional control rate of 78%. One patient had a preauricular nodal failure from an H&N primary lesion, while the other presented as an in-transit metastasis in the thigh from a below the knee primary lesion. The 3yr failure rate in the unirradiated nodal region was 10%. Distant metastases developed in 3 patients (3yr DM rate 74%) at a median time from diagnosis of 0.3 yrs. Three patients have died of MCC. Of those with positive SLNs (n = 3), 2 underwent completion lymph node dissection followed by regional nodal irradiation, while 1 patient received regional nodal irradiation alone. No further failures were seen in the regional nodal basin of patients with an initial positive SLN. The median age of the cohort at presentation was 76 yrs (range, 48-90 yrs) and the median tumor size was 2.2 cm (range, 0.3-4.7 cm). A SLN was identified in 13 of 15 patients for a success rate of 87%. A total of 21 SLNs were retrieved for a median of 2 SLNs per patient (mean 1.6). For the 2 patients who were unable to be mapped, 1 patient had a limited LN dissection identifying a single negative LN, while no additional LN assessment was performed in the other patient. Three of 13 patients (23%) had evidence of MCC in the SLN specimen, each with one positive LN. Patients with a negative SLNB received radiation to the surgical bed alone. One patient had a recurrence in the surgical bed for a 3yr local control rate of 80%. Two patients with negative SLNB had evidence of regional failure for a 3yr regional control rate of 78%. One patient had a preauricular nodal failure from an H&N primary lesion, while the other presented as an in-transit metastasis in the thigh from a below the knee primary lesion. The 3yr failure rate in the unirradiated nodal region was 10%. Distant metastases developed in 3 patients (3yr DM rate 74%) at a median time from diagnosis of 0.3 yrs. Three patients have died of MCC. Of those with positive SLNs (n = 3), 2 underwent completion lymph node dissection followed by regional nodal irradiation, while 1 patient received regional nodal irradiation alone. No further failures were seen in the regional nodal basin of patients with an initial positive SLN. ConclusionsSLNB can accurately identify regional nodal disease in patients presenting with clinical stage I MCC. Exclusion of regional nodal irradiation in patients with negative SLNB results in appropriate regional control after post-operative irradiation to the surgical bed. SLNB can accurately identify regional nodal disease in patients presenting with clinical stage I MCC. Exclusion of regional nodal irradiation in patients with negative SLNB results in appropriate regional control after post-operative irradiation to the surgical bed." @default.
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• W2039698876 date "2008-09-01" @default.
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• W2039698876 title "Low Risk of Regional Recurrence in Merkel Cell Carcinoma with Post-operative Radiation and Negative Sentinel Lymph Node Biopsy" @default.
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