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

Autor: Lobo MM; Department of Cutaneous Oncology, A. C. Camargo Cancer Center, São Paulo, Brazil.; Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA., Wainstein AJA; Department of Post Graduation, Faculdade Ciências Médicas de Minas Gerais, Belo Horizonte, Brazil., Barros AV; Department of Surgical Oncology, Santa Casa de Misericordia, Maceio, Alagoas, Brazil., Oliveira AF; Department of Surgical Oncology, Universidade Federal de Juiz de Fora, Juiz de Fora, Brazil., Jafelicci AS; Department of Cutaneous Oncology, A. C. Camargo Cancer Center, São Paulo, Brazil., Molina AS; Department of Cutaneous Oncology, A. C. Camargo Cancer Center, São Paulo, Brazil., Bertolli E; Melanoma and Sarcoma Group-Oncology/Beneficencia Portuguesa Hospital, São Paulo, Brazil., Riccardi F; Hospital Santa Rita, Santa Casa de Misericórdia de Porto Alegre, Executive Director, Grupo Brasileiro de Melanoma, Porto Alegre, Rio Grande do Sul, Brazil., Cavarsan F; Honcord Clinic, Goias, Brazil., Belfort FA; Cutaneous Oncology and Sarcomas Group, Hospital Sírio Libanês, São Paulo, Brazil., Teixeira FJR; Department of Surgery, University of São Paulo, São Paulo, Brazil., DeBiasi GG; Hospital Unimed Litoral de Balneariu Camboriu, Santa Catarina, Brazil., Ribeiro HSC; Department of Upper GI and HPB Surgical Oncology, AC Camargo Cancer, São Paulo, Brazil., Almeida HIB; Santa Casa de Misericordia, Salvador, Bahia, Brazil., de Oliveira JL; Connective and Bone Tissue Section, National Cancer Institute of Brazil (INCA), Rio de Janeiro, Brazil., Duprat Neto JP; Department of Cutaneous Oncology, A. C. Camargo Cancer Center, São Paulo, Brazil., Rebolho JC; Surgical Oncology Department, Erasto Gaertner Hospital, Curitiba, Brazil., Nunes LF; Connective and Bone Tissue Section, National Cancer Institute of Brazil (INCA), Rio de Janeiro, Brazil., Junior MJPC; Department of Cutaneous Oncology, A. C. Camargo Cancer Center, São Paulo, Brazil., Brandao MA; AMO Clinic, Salvador, Brazil., Brandao PHDM; Unionco Clinic Recife, Recife, Pernambuco, Brazil., de Souza RO; Instituto Avancado de Cancer de Pele, Mato Grosso do Sul, Brazil., Vazquez VL; Research and Education Institute, Barretos Cancer Hospital, Barretos, Brazil., Pinheiro RN; Surgical Oncology Service, Base Hospital of Federal District, Federal District, Brasília, Brazil.
Jazyk: angličtina
Zdroj: Journal of surgical oncology [J Surg Oncol] 2024 Sep; Vol. 130 (4), pp. 861-868. Date of Electronic Publication: 2024 Jun 06.
DOI: 10.1002/jso.27728
Abstrakt: Background: Merkel 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.
Objectives: The Brazilian Society of Surgical Oncology developed this document aiming to guide the surgical oncology role in multimodal MCC management.
Methods: The consensus was established in three rounds of online discussion, achieving consensus on specific topics including diagnosis, staging, treatment, and follow-up.
Results: Patients 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.
Conclusion: This 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.
(© 2024 Wiley Periodicals LLC.)
Databáze: MEDLINE
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