背景:默克尔细胞癌(MCC)是一种罕见的神经内分泌皮肤癌,5年生存率低。手术和放射治疗是目前治疗局部和结节性疾病的一线治疗方法。
目的:巴西肿瘤外科学会制定本文件旨在指导肿瘤外科在多模式MCC管理中的作用。
方法:通过三轮在线讨论建立了共识,在包括诊断在内的特定主题上达成共识,分期,治疗,和后续行动。
结果:怀疑患有MCC的患者应接受免疫组织化学检查,并优选接受皮肤病理学家的病理学检查。初始分期应进行皮肤病学和淋巴结体格检查,结合互补成像。全身成像,优选使用正电子发射断层扫描(PET)或计算机断层扫描(CT)扫描,被推荐。由于需要多学科方法,我们建议所有病例都应在肿瘤委员会讨论,并尽快转介其他专业,减少潜在的治疗延误。我们建议所有临床I或II期患者均可接受与前哨淋巴结活检相关的局部切除。关于利润率大小的决定应考虑恢复时间,患者的合并症,和风险因素。前哨淋巴结阳性或存在危险因素的患者应在原发部位进行术后放射治疗。对于性能低下的患者,独家辐射是可行的选择。前哨淋巴结活检阳性的患者应进行淋巴结放疗或淋巴结清扫术。在患有淋巴结临床疾病的患者中,除了原发性肿瘤治疗,建议进行淋巴结放疗和/或淋巴结清扫术.晚期疾病患者最好参加临床试验,并在多学科会议上讨论。应在肿瘤委员会中单独讨论手术和放射治疗在转移性/晚期环境中的作用。
结论:本文件旨在标准化默克尔细胞癌的初步评估和治疗方案,优化巴西等中等收入国家的肿瘤学结果。
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.
OBJECTIVE: 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.
CONCLUSIONS: 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.