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Would you recommend adjuvant radiation therapy to the locoregional lymph node basins for Merkel cell carcinoma (MCC) with a solitary macroscopically positive lymph node (LN) without ECE after lymph node dissection?
Per the NCCN guidelines, in this specific scenario, adjuvant radiation therapy to the locoregional lymph nodes after lymph node dissection is not indicated. However, given the nature of MCC, should nodal radiation still be considered?
Answer from: Radiation Oncologist at Academic Institution
As always the need to prophylacticaly treat possible residual nodal disease is influenced by many factors. Histology a key factor. Merkle cell is usually one step ahead of treatment. In this case I would definitely treat the nodes at risk. I would also treat widely around the resected primary ...
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Answer from: Radiation Oncologist at Community Practice
Similar to melanoma, we have a higher threshold to treat nodes in the groin compared to H&N due to the higher lymphedema morbidity risk in the groin.
Following a comprehensive groin dissection, it is reasonable to watch the groin for a single small node positive MCC w/o ECE.
In the H&N, we...