How would you treat an elderly patient (ECOG 0-1) with locally advanced rectal cancer and synchronous Merkel cell cancer of the extremity requiring adjuvant RT?

Interesting - the flurry of activity came several months after I treated the patient.

The patient was not going to get further surgery for either.

I choose to treat with definitive CRT (Xeloda) to 54 Gy w VMAT. I treated the Merkel Cell with 30/10 at the same time, presuming the patient would have a...

Addressing the sub-questions:

1) Rectal cancer takes precedence in almost every case when dealing with Merkel cell. Of the two, Merkel is much less likely to be the life-limiting disease. So, I would first do whatever needs to be done for the rectal cancer and treat the Merkel cell only if it doesn'...

Excise the Merkel cell. Postop RT to the primary site and regional nodes. Simultaneously preop RT chemo to the rectum followed by surgery.

I would not do a sentinel node biopsy. Unless there is more convincing data, the false negative rate is 17%. I would treat them regardless unless it would mean ...

If this patient only had Merkel cell Cancer of the extremity then the ideal course is resection with sentinel lymph node biopsy followed by radiation to the extremity site. If sentinel node is positive, then complete node dissection with RT, or RT alone is recommended. There is no role of adjuvant s...