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Soo Park, MD
Soo Park, MD
Posted: Friday, October 31, 2025
There has been increased interest surrounding palliative radiotherapy (RT) to the liver as a possible therapy for improving symptoms and liver function in patients with liver metastases. However, few reports have documented the use of RT specifically for patients with Merkel cell carcinoma (MCC), a disease with a generally poor prognosis and few treatment options. In a case study published in Case Reports in Oncology, Yuki Nagamura, MD, and colleagues described the use of palliative RT to alleviate gastrointestinal symptoms and improve liver function in a patient with MCC involving multiple liver lesions.
The study involved a 66-year-old woman with a history of chronic lymphocytic leukemia and small lymphocytic lymphoma who was diagnosed with primary MCC of the left nasal wing in late 2022. After surgery and adjuvant RT, she experienced regional recurrence that was treated with intensity-modulated RT, yielding a complete response. However, approximately 6 months later, the patient developed another recurrence, which was followed by widespread bone and liver metastases. At that time, palliative RT was administered to the metastases (20 Gy in five fractions), followed by treatment with the PD-L1 inhibitor avelumab. However, the patient experienced worsening symptoms (nausea, loss of appetite, and signs of hepatic dysfunction) and additional evaluations were performed. Contrast-enhanced computed tomography (CT) revealed liver dysfunction and rapidly progressing liver metastases. Shrinkage of the metastases in the left lobe of the liver was also observed, which was attributed to receipt of RT. Palliative RT was administered for an additional 2 weeks, after which the patient showed significant improvement in gastrointestinal symptoms and liver function. Contrast-enhanced CT at that point showed a good response to the metastases in the right lobe of the liver.
The patient experienced no treatment-related adverse effects after palliative RT, which provided meaningful symptomatic relief and enabled avelumab therapy to continue. This did not yield a sufficient therapeutic effect, however, and the patient died in June of 2024, 9 weeks after undergoing RT.
According to the authors, this case study demonstrates that palliative RT for multiple liver metastases of MCC can effectively improve symptoms and liver function, although they emphasize that additional data and clinical trials are needed to verify the safety and efficacy of liver RT in this patient population.
“In conclusion, palliative RT for liver metastases of MCC effectively improved symptoms and liver function. For patients with symptomatic liver metastases of MCC, palliative liver RT should be considered a treatment option. Further studies are necessary to strengthen the evidence,” they stated.
Disclosure: The authors declare no conflicts of interest.
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