We are treating a 40 year-old male with a completely resected Merkel cell carcinoma of the medial aspect of the lower thigh, with pathologically involved multiple inguinal nodes (Stage IIIB). Considering its propensity for satellite and in-transit metastases, we have delineated the CTV T as the surgical bed plus 3-5cm margins. We have likewise delineated the CTV N as the inguinal region down to before the vessels enter the Hunter's canal, at about the level of the lesser trochanter. There is an intervening 10-15 cm segment between the two CTVs.
Would you treat the skin and subcutaneous fat overlying the Hunter's canal in this segment to address the probability of in-transit metastases?
Is there a published guideline or data on CTV delineation for adjuvant radiotherapy for Merkel cell carcinoma?
i suggest you that study following paper
https://www.redjournal.org/article/S0360-3016(16)32747-X/pdf
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