Improving the odds
Known as MCC, this cancer appears as a lump of discolored cells growing in or right below the skin. It is routinely treated through surgical removal of the lump and any involved lymph nodes.
Few cases are reported in the United States — about 1,200 a year — but physicians must find better answers for it. “This particular cancer has a very high likelihood of recurrence after surgical treatment,” said Joshua D. I. Ellenhorn, M.D., of the Division of Surgery. Overall, recurrence rates range from 50 to 79 percent.
But Ellenhorn and a team of City of Hope physicians and statisticians have shown that today’s existing treatment tools can help these patients live longer, if physicians use them. They found that giving patients radiation therapy after surgery significantly improves patients’ survival. Published in the Journal of Clinical Oncology, the group’s findings shed much-needed light on treatment for the disease.
Ellenhorn and Pablo Mojica-Manosa, M.D., also of the Division of Surgery, analyzed treatment data using a large database of cancer statistics called the Surveillance, Epidemiology and End Results Registry. Biostatistician David Smith, Ph.D., of the Division of Information Sciences, participated in the research as well.
photo: Elise LamarPablo Mojica-Manosa, left, and Joshua D.I. Ellenhorn
Previous studies had suggested that MCC cells were “radiosensitive,” meaning that they are vulnerable to radiation treatment. Yet before this study, no one was sure whether radiation would truly benefit patients.
Mojica-Manosa, Smith and Ellenhorn surveyed 1,665 cases of MCC and found that only 40 percent of patients had received follow-up radiation after the tumor mass was removed. But that group had a median survival of 63 months, significantly longer than the 45 months seen in patients who had not received radiation. Clearly, radiation treatment improved patients’ prospects.
“Ours is the first study to show that use of radiation is beneficial at all stages and for all sizes of tumors, and improves survival,” said Ellenhorn. The benefits of radiation also were apparent across gender and race/ethnicity lines.
Even though less than half of those with the cancer nationwide now receive auxiliary radiation therapy, Ellenhorn says most MCC patients at City of Hope undergo the treatment, and he hopes the study will encourage the practice elsewhere. “Many physicians don’t know how to treat it,” he said. “The tumor looks innocuous and is managed by simple excision, and many physicians don’t think of treating it with radiation. The idea behind this paper was to use the largest possible database to determine whether radiation treatment was effective.”