Brazilian Society of Surgical Oncology recommendations on Merkel cell carcinoma surgical treatment

被引:1
作者
Lobo, Matheus de Melo [1 ,2 ]
Wainstein, Alberto Julius Alves [3 ]
Barros, Aldo Vieira [4 ]
Oliveira, Alexandre Ferreira [5 ]
Jafelicci, Andrea Schiavinato [1 ]
Molina, Andre Sapata [1 ]
Bertolli, Eduardo [6 ]
Riccardi, Felice [7 ]
Cavarsan, Flavio [8 ]
Belfort, Francisco Aparecido [9 ]
Teixeira, Frederico Jose Ribeiro [10 ]
Debiasi, Gustavo Galvan [11 ]
Ribeiro, Heber Salvador de Castro [12 ]
Almeida, Herbert Ives Barretto [13 ]
de Oliveira, Jadivan Leite [14 ]
Duprat Neto, Joao Pedreira [1 ]
Rebolho, Juliano Camargo [15 ]
Nunes, Luiz Fernando [14 ]
Coelho Junior, Manoel Jesus Pinheiro [1 ]
Brandao, Miguel Angelo [16 ]
Brandao, Paulo Henrique Domingues Miranda [17 ]
de Souza, Rafael Oliveira [18 ]
Vazquez, Vinicius de Lima [19 ]
Pinheiro, Rodrigo Nascimento [20 ]
机构
[1] AC Camargo Canc Ctr, Dept Cutaneous Oncol, Rua Pires da Mota 1167, BR-01529001 Sao Paulo, SP, Brazil
[2] Harvard Med Sch, Brigham & Womens Hosp, Dept Med, Boston, MA USA
[3] Fac Ciencias Med Minas Gerais, Dept Post Grad, Belo Horizonte, Brazil
[4] Santa Casa de Misericordia, Dept Surg Oncol, Maceio, Alagoas, Brazil
[5] Univ Fed Juiz de Fora, Dept Surg Oncol, Juiz De Fora, Brazil
[6] Beneficencia Portuguesa Hosp, Melanoma & Sarcoma Grp Oncol, Sao Paulo, Brazil
[7] Hosp Santa Rita, Santa Casa de Misericordia Porto Alegre, Porto Alegre, Brazil
[8] Honcord Clin, Goiania, GO, Brazil
[9] Hosp Sirio Libanes, Cutaneous Oncol & Sarcomas Grp, Sao Paulo, Brazil
[10] Univ Sao Paulo, Dept Surg, Sao Paulo, Brazil
[11] Hosp Unimed Litoral de Balneariu Camboriu, Balneario, SC, Brazil
[12] AC Camargo Canc, Dept Upper GI & HPB Surg Oncol, Sao Paulo, Brazil
[13] Santa Casa de Misericordia, Salvador, BA, Brazil
[14] Natl Canc Inst Brazil INCA, Connect & Bone Tissue Sect, Rio De Janeiro, Brazil
[15] Erasto Gaertner Hosp, Surg Oncol Dept, Curitiba, Brazil
[16] AMO Clin, Salvador, Brazil
[17] Unionco Clin Recife, Recife, PE, Brazil
[18] Inst Avancado Canc Pele, Campo Grande, MS, Brazil
[19] Barretos Canc Hosp, Res & Educ Inst, Barretos, Brazil
[20] Base Hosp Fed Dist, Surg Oncol Serv, Brasilia, DF, Brazil
关键词
consensus; Merkel cell; surgery; LYMPH-NODE BIOPSY; ISOLATED LIMB PERFUSION; RADIATION-THERAPY; PROGNOSTIC-FACTORS; IMPROVED SURVIVAL; RADIOTHERAPY; EXPERIENCE; DISSECTION; DIAGNOSIS;
D O I
10.1002/jso.27728
中图分类号
R73 [肿瘤学];
学科分类号
100214 ;
摘要
BackgroundMerkel cell carcinoma (MCC) is a rare neuroendocrine skin cancer with poor 5-year survival rates. Surgery and radiation are the current first-line treatments for local and nodal disease.ObjectivesThe Brazilian Society of Surgical Oncology developed this document aiming to guide the surgical oncology role in multimodal MCC management.MethodsThe consensus was established in three rounds of online discussion, achieving consensus on specific topics including diagnosis, staging, treatment, and follow-up.ResultsPatients suspected of having MCC should undergo immunohistochemical examination and preferably undergo pathology review by a dermatopathologist. Initial staging should be performed with dermatologic and nodal physical examination, combined with complementary imaging. Whole-body imaging, preferably with positron emission tomography (PET) or computed tomography (CT) scans, are recommended. Due to the need for multidisciplinary approaches, we recommend that all cases should be discussed in tumor boards and referred to other specialties as soon as possible, reducing potential treatment delays. We recommend that all patients with clinical stage I or II may undergo local excision associated with sentinel lymph node biopsy. The decision on margin size should consider time to recovery, patient's comorbidities, and risk factors. Patients with positive sentinel lymph nodes or the presence of risk factors should undergo postoperative radiation therapy at the primary site. Exclusive radiation is a viable option for patients with low performance. Patients with positive sentinel lymph node biopsy should undergo nodal radiation therapy or lymphadenectomy. In patients with nodal clinical disease, in addition to primary tumor treatment, nodal radiation therapy and/or lymphadenectomy are recommended. Patients with advanced disease should preferably be enrolled in clinical trials and discussed in multidisciplinary meetings. The role of surgery and radiation therapy in the metastatic/advanced setting should be discussed individually and always in tumor boards.ConclusionThis document aims to standardize a protocol for initial assessment and treatment for Merkel cell carcinoma, optimizing oncologic outcomes in middle-income countries such as Brazil.
引用
收藏
页码:861 / 868
页数:8
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