[Radiotherapy of chloroma or granulocytic sarcoma: A literature review]

Regression of a Myeloid Sarcoma of the Nasal Cavity With Extension to the Cheek After Radiotherapy

Myeloid sarcoma is rare and nasal chloroma is an uncommon initial manifestation of acute myeloid leukaemia. The correct diagnosis is a big challenge. In this report, we present a case of myeloid sarcoma of the nasal cavity with extension to the soft tissues of the face. A 53-year-old woman with a past medical history of thalassemia, not followed up, presented with a progressive greyish swelling in her right cheek associated with a nasal obstruction more marked on the right side and unilateral lacrimation. The diagnosis of myeloid sarcoma was based on histopathology and immunohistochemistry. Bone marrow aspiration testing revealed blasts that met the criteria for acute leukaemia. She received external radiotherapy at a total dose of 30 Gy in 15 fractions without systemic therapy, because she refused to get chemotherapy. She remained under surveillance and symptomatic treatment. The patient was examined four months after the end of the irradiation and showed a spectacular improvement in her clinical symptomatology with a clear decrease in nasal mass.

[Bilateral orbital myeloid sarcoma: the circumstance of the discovery of acute myeloid leukemia (a case report)]

Le sarcome myéloïde est une forme rare parmi les manifestations oculaires au cours de la leucémie aiguë myéloïde. Le caractère bilatéral et précédant tout signe clinique de la leucémie est d´autant plus rare. Nous rapportons le cas d´un patient de 16 mois consultant pour une exophtalmie aigue bilatérale d´allure inflammatoire, rapidement progressive, avec une kératite d´exposition. La tomodensitométrie oculo-cérébrale montrait une infiltration d´allure tissulaire bilatérale occupant la cavité orbitaire. Le bilan sanguin montrait un syndrome inflammatoire biologique, une bicytopénie et une blastose circulante à 83%. La présence de blastes circulant a motivé la réalisation d´un myélogramme qui a permis d´établir le diagnostic de leucémie aiguë myéloïde 4. Devant une exophtalmie, même bilatérale, il faut penser au sarcome myéloïde et étudier minutieusement les résultats de l´hémogramme.

Radiotherapy for isolated granulocytic sarcoma: Case report and review of literature

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Isolated chloroma should be considered as a systemic disease.

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Consolidation radiotherapy has been related with prolonged failure free survival.

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Excellent local control of chloroma is achieved with low-dose radiotherapy.

Adaptive Radiotherapy for an Uncommon Chloroma

Granulocytic sarcomas, also referred to as chloromas or myeloid sarcomas, are extramedullary neoplasms that are composed of immature myeloid cells. This uncommon disease is known to be radiosensitive. However, the total dose and dose per fraction are not standardized. In addition, during the course of radiation therapy, significant reduction of the tumor is usually obtained. Thus, target volume reduction may require an intermediate radiotherapy plan evaluation for an adaptive treatment. A second plan at mid-dose is highly recommended.

Radiation Therapy in Paediatric Orbital Granulocytic Sarcomas: Experience from a Tertiary Cancer Center

INTRODUCTION

Orbital Granulocytic Sarcoma (OGS) is an uncommon manifestation associated with haematological malignancies. Chemotherapy remains the cornerstone of the treatment. The role of radiation is not well-defined.

AIM

To evaluate the effect of radiation in OGS and to define an optimal dose for achieving adequate local control.

MATERIALS AND METHODS

This was a retrospective analysis of 11 patients who received radiation therapy to orbit for Granulocytic Sarcoma (GS) between 2007 and 2014 at a tertiary cancer center in India. Radiotherapy was planned by three dimensional conformal (3DCRT) techniques. Demographic and disease characteristics, including clinical, imaging, histopathology and treatment details in this patient cohort were recorded and their response to therapy was assessed.

RESULTS

The median age was 7 years (Range: 2-16 years). There were 3 female and 8 male patients. Eight patients were diagnosed as Acute Myelogenous Leukemia (AML), two patients had Primary Orbital Granulocytic Sarcoma (POGS) and one had bi-phenotypic leukemia. Median dose was 24.5Gy (Range-15-45 Gy). Two anterior oblique field design were used most commonly. Out of 11 patients, 5 (45.4%) had complete response, 3 (27.27%) had partial response, 1 patient had stable disease (9%) and 2 developed progressive disease (18%). Median follow-up was 24 months (Range 24-84 months). At last follow-up, 7 (63.6%) patients were alive and 4 patients (37.4%) were dead due to progressive disease.

CONCLUSION

In patients with residual orbital disease after chemotherapy, low dose radiation can be used to improve local disease control and improve quality of life. Local conformal radiotherapy of 24-30 Gy in conventional fractionation appears optimal with excellent local control and minimal morbidity.