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Goyal A, O'Leary D, Dabaja B, Weng WK, Zain J, Cutler C, Guitart J, Kim YH, Geskin LJ, Hoppe RT, Wilson LD, Beaven AW, Horwitz S, Allen PB, Barta SK, Bohjanen K, Brammer JE, Carter JB, Comfere N, DeSimone JA, Dusenbery K, Duvic M, Huen A, Jagadeesh D, Kelsey CR, Khodadoust MS, Lechowicz MJ, Mehta-Shah N, Moskowitz AJ, Olsen EA, Poh C, Pro B, Querfeld C, Sauter C, Sokol L, Sokumbi O, Wilcox RA, Zic JA, Hamadani M, Foss F. ASTCT and USCLC Clinical Practice Recommendations for Allogeneic Stem Cell Transplant in Mycosis Fungoides and Sézary Syndrome. Transplant Cell Ther 2024:S2666-6367(24)00621-3. [PMID: 39222792 DOI: 10.1016/j.jtct.2024.08.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2024] [Accepted: 08/26/2024] [Indexed: 09/04/2024]
Abstract
Mycosis fungoides (MF) and Sézary syndrome (SS) are the most common subtypes of cutaneous T-cell lymphoma (CTCL). While MF generally follows an indolent course, a subset of patients will experience progressive and/or treatment-refractory disease; Sézary syndrome is an aggressive lymphoma associated with high morbidity and mortality. Although allogeneic hematopoietic cell transplant (allo-HCT) is the only currently available potentially curative treatment modality for MF/SS there is no published guidance on referral criteria, transplant timing orallo-HCT approach. To develop consensus clinical practice recommendations, we performed a Delphi survey of 32 specialists in dermatology (n = 9), transplant hematology/oncology (n = 10), non-transplant hematology/oncology (n = 8), and radiation oncology (n = 5) from across the United States. Consensus required agreement of ≥75% of participants. Sixteen consensus statements were generated on four topics: (1) criteria for referral for consideration for allo-HCT, (2) allo-HCT preparative regimens and procedures (3) disease status at the time of allo-HCT, and (4) multidisciplinary management in the pre- and post-transplant settings. These clinical practice guidelines provide a framework for decision-making regarding allo-HCT for MF/SS and highlight areas for future prospective investigation.
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Affiliation(s)
- Amrita Goyal
- Department of Dermatology, University of Minnesota, Minneapolis, Minnesota.
| | - Daniel O'Leary
- Division of Hematology, Oncology, and Transplantation, University of Minnesota, Minneapolis, Minnesota
| | - Bouthaina Dabaja
- Department of Radiation Oncology, University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Wen-Kai Weng
- Blood and Marrow Transplantation, and Cellular Therapy, Department of Medicine, Stanford University, Stanford, California
| | - Jasmine Zain
- Division of Lymphoma, Department of Hematology & Hematopoietic Cell Transplantation, City of Hope National Medical Center, Duarte, California
| | - Corey Cutler
- Division of Transplantation and Cellular Therapy, Dana-Farber Cancer Institute, Boston, Massachusetts
| | - Joan Guitart
- Department of Dermatology, Northwestern Feinberg School of Medicine, Evanston, Illinois
| | - Youn H Kim
- Departments of Dermatology and Medicine/Division of Oncology, Stanford University, Stanford, California
| | - Larisa J Geskin
- Department of Dermatology, Columbia University, New York, New York
| | - Richard T Hoppe
- Department of Radiation Oncology, Stanford University, Stanford, California
| | - Lynn D Wilson
- Department of Therapeutic Radiology, Yale School of Medicine, New Haven, Connecticut
| | - Anne W Beaven
- Division of Hematology, University of North Carolina, Chapel Hill, North Carolina
| | - Steve Horwitz
- Lymphoma Service, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Pamela B Allen
- Department of Hematology & Medical Oncology, Emory University Winship Cancer Institute, Atlanta, Georgia
| | - Stefan K Barta
- Division of Hematology and Oncology, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Kimberly Bohjanen
- Department of Dermatology, University of Minnesota, Minneapolis, Minnesota
| | - Jonathan E Brammer
- Division of Hematology, Ohio State University James Comprehensive Cancer Center, Columbus, Ohio
| | - Joi B Carter
- Department of Dermatology, Dartmouth Hitchcock Medical Center, Lebanon, New Hampshire
| | - Nneka Comfere
- Departments of Dermatology and Laboratory Medicine & Pathology, Mayo Clinic, Rochester, Minnesota
| | - Jennifer A DeSimone
- Department of Dermatology, University of Virginia Schar Cancer Institute, Fairfax, Virginia
| | - Kathryn Dusenbery
- Department of Radiation Oncology, University of Minnesota, Minneapolis, Minnesota
| | - Madeleine Duvic
- Department of Dermatology, University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Auris Huen
- Department of Dermatology, University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Deepa Jagadeesh
- Department of Hematology and Medical Oncology, Cleveland Clinic Taussig Cancer Center, Cleveland, Ohio
| | - Chris R Kelsey
- Department of Radiation Oncology, Duke University Medical Center, Durham, North Carolina
| | - Michael S Khodadoust
- Division of Oncology, Department of Medicine, Stanford University, Stanford, California
| | - Mary Jo Lechowicz
- Department of Hematology and Medical Oncology, Emory University, Atlanta, Georgia
| | - Neha Mehta-Shah
- Department of Medicine, Division of Oncology, Washington University School of Medicine in St. Louis, St. Louis, Missouri
| | - Alison J Moskowitz
- Lymphoma Service, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Elise A Olsen
- Departments of Dermatology and Medicine, Duke University Medical Center, Durham, North Carolina
| | - Christina Poh
- Division of Hematology and Oncology, University of Washington, Seattle, Washington
| | - Barbara Pro
- Department of Hematology and Oncology, New York Presbyterian - Columbia University Irving Medical Center, New York, New York
| | - Christiane Querfeld
- Department of Pathology, Division of Dermatology & Beckman Research Institute, City of Hope National Medical Center, Duarte, California
| | - Craig Sauter
- Department of Hematology and Medical Oncology, Cleveland Clinic Taussig Cancer Center, Cleveland, Ohio
| | - Lubomir Sokol
- Malignant Hematology, Moffitt Cancer Center, Tampa, Florida
| | - Olayemi Sokumbi
- Departments of Dermatology and Laboratory Medicine & Pathology, Mayo Clinic, Jacksonville, Florida
| | - Ryan A Wilcox
- Division of Internal Medicine, Division of Hematology/Oncology, University of Michigan, Ann Arbor, Michigan
| | - John A Zic
- Department of Dermatology, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Mehdi Hamadani
- Division of Hematology & Oncology, Department of Medicine, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Francine Foss
- Department of Hematology/Oncology, Yale University School of Medicine, New Haven, Connecticut
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Schiavone C, Vagge S, Ruggieri FG. Radiation therapy in mycosis fungoides. Dermatol Reports 2024; 16:9885. [PMID: 39295881 PMCID: PMC11406205 DOI: 10.4081/dr.2024.9885] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2023] [Accepted: 11/20/2023] [Indexed: 09/21/2024] Open
Abstract
Radiation therapy (RT) is administered with varying intentions, sometimes even several times in the same or in different body areas, to over 50% of patients with neoplastic conditions. Numerous techniques are available to patients in the clinical evolution of mycosis fungoides (MF), and there are several indications for radiation therapy (RT). RT as a skin-directed therapy is very widely used in these patients, either alone or in conjunction with other therapies. The application of RT, a tried-and-true therapy that improves MF patients' quality of life and treatment, can be encouraged by a multidisciplinary approach and an understanding of current methods and action mechanisms.
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Aires D, Abhyankar S. Early intervention of extracorporeal photopheresis for advancing/progressing cutaneous T-cell lymphoma. Hematol Oncol 2023; 41:809-816. [PMID: 37974524 DOI: 10.1002/hon.3229] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2022] [Revised: 08/18/2023] [Accepted: 09/08/2023] [Indexed: 11/19/2023]
Abstract
Patients with cutaneous T-cell lymphoma with progressive disease typically undergo a series of skin-directed and systemic therapy regimens during cycles of response and relapse. Extracorporeal photopheresis (ECP) is an effective and safe systemic treatment option, often reserved for later stages of disease and typically employed after failure of several other therapies. ECP has benefits in response rate, time to next treatment, and tolerability that may support its use earlier in the treatment cycle for advancing/progressing disease.
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Affiliation(s)
| | - Sunil Abhyankar
- University of Kansas Cancer Center and the University of Kansas Medical Center, Kansas City, Kansas, USA
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Suggested Guidelines for the Treatment of Mycosis Fungoides in Countries with Limited Resources. Dermatol Res Pract 2023; 2023:1360740. [PMID: 36762366 PMCID: PMC9904957 DOI: 10.1155/2023/1360740] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2022] [Revised: 01/13/2023] [Accepted: 01/17/2023] [Indexed: 02/04/2023] Open
Abstract
The treatment options for mycosis fungoides (MF) have been expanding but unfortunately many of the currently used treatment modalities are unavailable in Egypt and other African/Arab countries. In addition, there is a lack of consensus on the treatment of hypopigmented MF (HMF), which is a frequently encountered variant in our population. We aimed to develop regional treatment guidelines based on the international guidelines but modified to encompass the restricted treatment availability and our institutional experience. Special attention was also given to studies conducted on patients with skin phototype (III-IV). Treatment algorithm was formulated at Ain-Shams cutaneous lymphoma clinic through the collaboration of dermatologists, haematologists, and oncologists. Level of evidence is specified for each treatment option. For HMF, phototherapy is recommended as a first line treatment, while low-dose methotrexate is considered a second line. For early classical MF, we recommend Psoralen-ultraviolet A (PUVA), which is a well-tolerated treatment option in dark phenotype. Addition of either retinoic acid receptor (RAR) agonist and/or methotrexate is recommended as a second line. Total skin electron beam (TSEB) is considered a third-line option. For advanced stage, PUVA plus RAR agonist and/or methotrexate is recommended as first line, TSEB or monochemotherapy is considered a second line option. Polychemotherapy is regarded as a final option. All patients with complete response (CR) enter a maintenance and follow-up schedule. We suggest a practical algorithm for the treatment of MF for patients with dark phenotype living in countries with limited resources.
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Shreberk-Hassidim R, Geiger-Maor A, Eisenberg G, Merims S, Hajaj E, Cohen JE, Klein S, Frankenburg S, Moyal L, Hodak E, Zlotogorski A, Lotem M. The role of immune checkpoint receptors in the malignant phenotype of cutaneous T cell lymphoma. Immunol Res 2022; 70:793-799. [PMID: 35867216 DOI: 10.1007/s12026-022-09308-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2022] [Accepted: 07/13/2022] [Indexed: 11/30/2022]
Abstract
Immune checkpoint receptors (ICR) modulate the immune response and are critical hubs for immunotherapy. However, data on their role in T lymphoid malignancies, such as cutaneous T cell lymphoma (CTCL), is sparse. We aimed to explore the role of ICR in the malignant features of transformed T lymphocytes and evaluate the effect of ICR-targeting monoclonal antibodies, often used as immunotherapy for solid tumors. We used the CTCL cell line HH and the Sézary cell line Hut78 to examine ICR expression and the effects of ICR inhibition on cell viability and proliferation. Despite their shared T cell progeny, the different CTCL cell lines exhibit markedly different ICR expression profiles. Programmed cell death-ligand 1 (PD-L1) was expressed by both cell lines, while programmed death-1 (PD-1) was expressed only by the HH cell line. Common to all malignant T cells was an autonomous hyper-proliferative state that did not require T cell receptor stimulation. A monoclonal antibody blocking PD-1 had a small but statistically significant augmenting effect on T cell proliferation. Of note, when the cells were exposed to ionizing radiation, healthy lymphocytes and those derived from the HH cell line were salvaged by anti-PD-L1. We show a regulatory role of ICR, mainly PD-1 and its ligand PD-L1, on cutaneous T cell malignancy.
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Affiliation(s)
- Rony Shreberk-Hassidim
- Department of Dermatology, The Faculty of Medicine, Hadassah Medical Center, Hebrew University of Jerusalem, Jerusalem, Israel.
| | - Anat Geiger-Maor
- The Faculty of Medicine, Sharett Institute of Oncology, Hadassah Medical Center, Hebrew University of Jerusalem, Jerusalem, Israel
| | - Galit Eisenberg
- The Faculty of Medicine, Sharett Institute of Oncology, Hadassah Medical Center, Hebrew University of Jerusalem, Jerusalem, Israel
| | - Sharon Merims
- The Faculty of Medicine, Sharett Institute of Oncology, Hadassah Medical Center, Hebrew University of Jerusalem, Jerusalem, Israel
| | - Emma Hajaj
- The Faculty of Medicine, Sharett Institute of Oncology, Hadassah Medical Center, Hebrew University of Jerusalem, Jerusalem, Israel
| | - Jonathan E Cohen
- The Faculty of Medicine, Sharett Institute of Oncology, Hadassah Medical Center, Hebrew University of Jerusalem, Jerusalem, Israel.,The Wohl Institute for Translational Medicine, Hadassah Medical Center, Jerusalem, Israel
| | - Shiri Klein
- The Faculty of Medicine, Sharett Institute of Oncology, Hadassah Medical Center, Hebrew University of Jerusalem, Jerusalem, Israel
| | - Shoshana Frankenburg
- The Faculty of Medicine, Sharett Institute of Oncology, Hadassah Medical Center, Hebrew University of Jerusalem, Jerusalem, Israel
| | - Lilach Moyal
- Department of Dermatology, Rabin Medical Center-Beilinson Hospital, Petah Tikva, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Emilia Hodak
- Department of Dermatology, Rabin Medical Center-Beilinson Hospital, Petah Tikva, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Abraham Zlotogorski
- Department of Dermatology, The Faculty of Medicine, Hadassah Medical Center, Hebrew University of Jerusalem, Jerusalem, Israel
| | - Michal Lotem
- The Faculty of Medicine, Sharett Institute of Oncology, Hadassah Medical Center, Hebrew University of Jerusalem, Jerusalem, Israel
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Banciu ML, Dobrica EC, Soare C, Malciu AM, Voiculescu VM. Healthcare Disparities in the Management of Indolent Mycosis Fungoides. Cureus 2022; 14:e24098. [PMID: 35573524 PMCID: PMC9106548 DOI: 10.7759/cureus.24098] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/13/2022] [Indexed: 11/18/2022] Open
Abstract
Mycosis fungoides represents the most common cutaneous T-cell lymphoma, clinically manifested with evolving skin lesions, including patches, plaques, tumors, and erythroderma. Early diagnosis remains difficult to establish because it mimics several benign skin conditions, but maintaining a high index of suspicion for the disease is essential in preventing the progression of a potentially fatal disease. We report the case of a 69-year-old female who presented in our dermatology clinic in 2018 with scaly, indurated, itchy erythematous-violaceus patches and plaques, and tumors disseminated throughout the skin evolving for nine years. Skin biopsy supplemented with immunohistochemical staining established the diagnosis of mycosis fungoides. Due to the equivocal clinical presentation and the lack of extracutaneous manifestations, the patient received conventional therapy according to the stage of the disease. The rapidly progressive evolution of the cutaneous lesions in the last year of the disease determined the patient’s death despite instituting systemic chemotherapy. Patient follow-up and a multidisciplinary approach are essential to diagnose and manage this disease in its early stages. This will prevent the progression to a life-threatening malignancy and the use of immunosuppressive therapy, which can cause serious side effects.
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Sweeping-beam technique with electrons for large treatment areas as total skin irradiation : Dosimetric and technical aspects of a modified Stanford technique. Strahlenther Onkol 2021; 198:47-55. [PMID: 34729625 DOI: 10.1007/s00066-021-01859-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2021] [Accepted: 09/19/2021] [Indexed: 10/19/2022]
Abstract
PURPOSE Total skin electron beam therapy (TSEBT) is still a technical and therapeutic challenge today. Thus, we developed TSEBT using a sweeping-beam technique. METHODS For treatment delivery, a linear accelerator Versa HD (ELEKTA, Stockholm, Sweden) with high-dose-rate electrons (HDRE) was used with a dose rate of 9000 MU/min. Dosimetry quality assurance was performed by multiple measurements with film dosimetry, 2D array, and Roos chamber. RESULTS Clinical experience shows that treatment durations of 75 to 90 min are usual for the Stanford technique without using HDRE. With this new sweeping-beam irradiation technique, the total treatment time of a daily fraction could be reduced to 20 min while keeping over- and underdosing low. The treatment area is about 60 cm × 200 cm and the dose distribution is uniform within 2% and 5% in vertical and horizontal directions, respectively. Initially, the electron energy of 6 MeV is reduced to 3.2 MeV by 1‑cm polymethylmethacrylat (PMMA) scatter and the irradiation conditions of a source-surface distance (SSD) of 350 cm. The photon contamination drops to under 1%. CONCLUSION These results show that the mean dose to total skin varies between 1.3 and 1.8 Gy. The sweeping-beam technique with electrons has a homogeneous dose distribution in connection with a short treatment time.
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Herrera A, Cheng A, Mimitou EP, Seffens A, George D, Bar-Natan M, Heguy A, Ruggles KV, Scher JU, Hymes K, Latkowski JA, Ødum N, Kadin ME, Ouyang Z, Geskin LJ, Smibert P, Buus TB, Koralov SB. Multimodal single-cell analysis of cutaneous T-cell lymphoma reveals distinct subclonal tissue-dependent signatures. Blood 2021; 138:1456-1464. [PMID: 34232982 PMCID: PMC8532199 DOI: 10.1182/blood.2020009346] [Citation(s) in RCA: 37] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2020] [Accepted: 04/03/2021] [Indexed: 11/20/2022] Open
Abstract
Cutaneous T-cell lymphoma (CTCL) is a heterogeneous group of mature T-cell neoplasms characterized by the accumulation of clonal malignant CD4+ T cells in the skin. The most common variant of CTCL, mycosis fungoides (MF ), is confined to the skin in early stages but can be accompanied by extracutaneous dissemination of malignant T cells to the blood and lymph nodes in advanced stages of disease. Sézary syndrome (SS), a leukemic form of disease, is characterized by significant blood involvement. Little is known about the transcriptional and genomic relationship between skin- and blood-residing malignant T cells in CTCL. To identify and interrogate malignant clones in matched skin and blood from patients with leukemic MF and SS, we combine T-cell receptor clonotyping with quantification of gene expression and cell surface markers at the single cell level. Our data reveal clonal evolution at a transcriptional and genetic level within the malignant populations of individual patients. We highlight highly consistent transcriptional signatures delineating skin- and blood-derived malignant T cells. Analysis of these 2 populations suggests that environmental cues, along with genetic aberrations, contribute to transcriptional profiles of malignant T cells. Our findings indicate that the skin microenvironment in CTCL promotes a transcriptional response supporting rapid malignant expansion, as opposed to the quiescent state observed in the blood, potentially influencing efficacy of therapies. These results provide insight into tissue-specific characteristics of cancerous cells and underscore the need to address the patients' individual malignant profiles at the time of therapy to eliminate all subclones.
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Affiliation(s)
- Alberto Herrera
- Department of Pathology, New York University School of Medicine, New York, NY
| | - Anthony Cheng
- Department of Genetic and Genome Sciences, University of Connecticut School of Medicine, Farmington, CT
- Department of Biostatistics and Epidemiology, School of Public Health and Health Sciences, University of Massachusetts, Amherst, MA
| | - Eleni P Mimitou
- Technology Innovation Laboratory, New York Genome Center, New York, NY
| | - Angelina Seffens
- Department of Pathology, New York University School of Medicine, New York, NY
- Columbia University Vagelos College of Physicians and Surgeons, New York, NY
| | - Dean George
- Department of Dermatology, Boston University and Roger Williams Medical Center, Brown University, Providence, RI
| | - Michal Bar-Natan
- Department of Pathology, New York University School of Medicine, New York, NY
- Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Adriana Heguy
- Department of Pathology, New York University School of Medicine, New York, NY
- Genome Technology Center, New York University School of Medicine, New York, NY
| | | | - Jose U Scher
- Division of Rheumatology, Department of Medicine
| | | | - Jo-Ann Latkowski
- Department of Dermatology, New York University School of Medicine, New York, NY
| | - Niels Ødum
- LEO Foundation Skin Immunology Research Center, Department of Immunology and Microbiology, University of Copenhagen, Copenhagen, Denmark
| | - Marshall E Kadin
- Department of Dermatology, Boston University and Roger Williams Medical Center, Brown University, Providence, RI
| | - Zhengqing Ouyang
- Department of Biostatistics and Epidemiology, School of Public Health and Health Sciences, University of Massachusetts, Amherst, MA
| | - Larisa J Geskin
- Department of Dermatology, Columbia University, New York, NY
| | - Peter Smibert
- Technology Innovation Laboratory, New York Genome Center, New York, NY
| | - Terkild B Buus
- Department of Pathology, New York University School of Medicine, New York, NY
- LEO Foundation Skin Immunology Research Center, Department of Immunology and Microbiology, University of Copenhagen, Copenhagen, Denmark
| | - Sergei B Koralov
- Department of Pathology, New York University School of Medicine, New York, NY
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Lyu WT, Song QB, Qiong W, Liu J, Yong R, Yi FT, Han DL. A case report of aggressive course of CD30+ primary cutaneous anaplastic large cell lymphoma. Medicine (Baltimore) 2021; 100:e25770. [PMID: 33950967 PMCID: PMC8104231 DOI: 10.1097/md.0000000000025770] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/18/2021] [Accepted: 04/15/2021] [Indexed: 01/04/2023] Open
Abstract
INTRODUCTION CD30+ primary cutaneous anaplastic large cell lymphoma (PC-ALCL) is a rare T-cell neoplasm, and has been reported to present with an indolent behavior. The PC-ALCL with aggressive behavior has not been reported in the literature. PATIENT CONCERNS We treated a patient with PC-ALCL that exhibited indolent behavior in the past 2 years and aggressive behavior within the last 3 months before presentation. DIAGNOSIS Aggressive CD30+ primary cutaneous anaplastic large cell lymphoma. INTERVENTIONS The radiotherapy regimen was individualized in terms of the target volume delineation and dose prescription, and the dose-response relationship was evaluated. OUTCOMES The mean distance of microscopic infiltration was 14.1 mm in depth and 14.3 mm circumferentially. The lesion completely regressed after the delivery of 40 Gy in 20 fractions over 4 weeks. The tumor did not recur over the next year. CONCLUSION An aggressive disease course is rare for indolent CD30+ PC-ALCL, which has similar histopathological characteristics as indolent PC-ALCL. The radiotherapy strategy should be individualized with curative intent.
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Affiliation(s)
- Wen-Tian Lyu
- Department of Oncology, Huanggang Center Hospital, Huangzhou District, Huanggang
| | - Qi-Bin Song
- Department of Oncology, Huanggang Center Hospital, Huangzhou District, Huanggang
| | | | - Jing Liu
- Department of Oncology, Huanggang Center Hospital, Huangzhou District, Huanggang
| | | | - Feng-Tao Yi
- Department of Radiation Oncology, General Hospital of Central Treater Command of PLA, Hongshan District, Wuhan, China
| | - Dong-liang Han
- Department of Radiation Oncology, General Hospital of Central Treater Command of PLA, Hongshan District, Wuhan, China
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Chellakhi M, Khalfaoui I, Benchakroun N, Bouchbika Z, Jouhadi H, Tawfiq N, Sahraoui S, Benider A, Chellakhi N, Quessar A. Radiation therapy in mycosis fungoid patient. Pan Afr Med J 2019; 33:227. [PMID: 31692791 PMCID: PMC6814898 DOI: 10.11604/pamj.2019.33.227.17701] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2019] [Accepted: 03/10/2019] [Indexed: 11/29/2022] Open
Abstract
Mycosis fungoid (MF) is a non-Hodgkin's T-cell lymphoma determined by primary cutaneous involvement. It is a slow-progressing chronic indolent disease characterized by atypical T-cells with a cerebral nucleus. Management of this disease depends on the stage and is based essentially on the systemic treatment. Radiotherapy intervenes in case of localized or extended tumor, indeed, the radiosensibility of this tumor, like any other hematological affection, makes it possible to obtain a high rate of response. Clinical case: we report the observation of a 46-year-old patient followed since 2012 for mycosis fungoid revealed by a papullo-squamous lesion located at the level of the right lumbar fossa. The diagnosis was confirmed by cutaneous biopsy, showing the presence of T lymphocytes expressing CD2, CD3, CD4, CCR4, CD45RO markers. Initial assessment included a thoraco-abdominal pelvic CT, which was normal, an accelerated sedimentation rate at the 1st hour, a high C reactive protein (CRP), the electrolytic, renal, hepatic status and the hemogram were normal. Patient received 6 courses of chemotherapy according to the COPP protocol with a decrease in the size of the lesion estimated at 40%. A norm fractionated radiation therapy was delivered at the dose of 36Gy. The evolution was marked by a complete remission, maintained after 6 months of the treatment. Mycosis fungoid is a rare disease, whose management must be discussed in a multidisciplinary team. Radiotherapy remains an interesting option for all stages, but has to be validated in largest studies.
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Affiliation(s)
- Madiha Chellakhi
- Centre Mohammed VI de Traitement du Cancer, CHU Ibn Rochd, Casablanca, Maroc
| | - Ilham Khalfaoui
- Centre Mohammed VI de Traitement du Cancer, CHU Ibn Rochd, Casablanca, Maroc
| | - Nadia Benchakroun
- Centre Mohammed VI de Traitement du Cancer, CHU Ibn Rochd, Casablanca, Maroc
| | - Zineb Bouchbika
- Centre Mohammed VI de Traitement du Cancer, CHU Ibn Rochd, Casablanca, Maroc
| | - Hassan Jouhadi
- Centre Mohammed VI de Traitement du Cancer, CHU Ibn Rochd, Casablanca, Maroc
| | - Nezha Tawfiq
- Centre Mohammed VI de Traitement du Cancer, CHU Ibn Rochd, Casablanca, Maroc
| | - Souha Sahraoui
- Centre Mohammed VI de Traitement du Cancer, CHU Ibn Rochd, Casablanca, Maroc
| | - Abdellatif Benider
- Centre Mohammed VI de Traitement du Cancer, CHU Ibn Rochd, Casablanca, Maroc
| | - Nabila Chellakhi
- Service d'Hématologie et d'Oncologie Pédiatrique Hopital 20 Aout 1953, CHU Ibn Rochd, Casablanca, Maroc
| | - Asmaa Quessar
- Service d'Hématologie et d'Oncologie Pédiatrique Hopital 20 Aout 1953, CHU Ibn Rochd, Casablanca, Maroc
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Buglione M, Spiazzi L, Urpis M, Baushi L, Avitabile R, Pasinetti N, Borghetti P, Triggiani L, Pedretti S, Saiani F, Fiume A, Greco D, Ciccarelli S, Polonini A, Moretti R, Magrini SM. Light and shadows of a new technique: is photon total-skin irradiation using helical IMRT feasible, less complex and as toxic as the electrons one? Radiat Oncol 2018; 13:158. [PMID: 30157892 PMCID: PMC6114532 DOI: 10.1186/s13014-018-1100-4] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2018] [Accepted: 08/14/2018] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND Radiotherapy is one of the standard treatments for cutaneous lymphoma and Total Skin Electrons Beam Irradiation (TSEBI) is generally used to treat diffuse cutaneous lymphoma and some cases of localized disease. Helical IMRT (HI) allows to treat complex target with optimal dose distribution and organ at risk sparing, so helical tomotherapy has been proposed as alternative technique to TSEBI but only one preliminary report has been published. METHODS Three patients treated (from May 2013 to December 2014) with Helical IMRT, with a total dose between 24 and 30 Gy, were retrospectively evaluated. Data about dosimetric features, response and acute toxicity were registered and analyzed. Planned target coverage was compared with daily in vivo measures and dose calculation based on volumetric images used for set up evaluation as well. RESULTS The patients had a mean measured surface fraction dose ranging from 1.54 Gy up to 2.0 Gy. A planned target dose ranging from 85 to 120% of prescription doses was obtained. All doses to Organs At Risk were within the required constraints. Particular attention was posed on "whole bone marrow" planned V10Gy, V12Gy and V20Gy values, ranging respectively between 23 and 43%, 20.1 and 38% and 9.8 and 24%. A comparison with the theoretical homologous values obtained with TSEBI has shown much lower values with TSEBI. Even if treatment was given in sequence to the skin of the upper and lower hemi-body, all the patients had anaemia, requiring blood transfusions, leukopenia and thrombocytopenia. CONCLUSION Based on our limited results TSEBI should still be considered the standard method to treat total skin because of its pattern of acute and late toxicities and the dose distribution. In this particular case the better target coverage obtained with HI can be paid in terms of worse toxicity. Helical IMRT can instead be considered optimal in treating large, convex, cutaneous areas where it is difficult to use multiple electrons fields in relation with the clinical results and the limited and reversible toxicities.
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Affiliation(s)
- Michela Buglione
- Radiation Oncology Department, University and Spedali Civili Hospital – Brescia, P.le Spedali Civili 1 –, 25123 Brescia, Italy
| | - Luigi Spiazzi
- Medical Physics, Spedali Civili Hospital – Brescia, P.le Spedali Civili 1 –, 25123 Brescia, Italy
| | - Mauro Urpis
- Radiation Oncology Department, University and Spedali Civili Hospital – Brescia, P.le Spedali Civili 1 –, 25123 Brescia, Italy
| | - Liliana Baushi
- Radiation Oncology Department, University and Spedali Civili Hospital – Brescia, P.le Spedali Civili 1 –, 25123 Brescia, Italy
| | - Rossella Avitabile
- Medical Physics, Spedali Civili Hospital – Brescia, P.le Spedali Civili 1 –, 25123 Brescia, Italy
| | - Nadia Pasinetti
- Radiation Oncology Department, University and Spedali Civili Hospital – Brescia, P.le Spedali Civili 1 –, 25123 Brescia, Italy
| | - Paolo Borghetti
- Radiation Oncology Department, University and Spedali Civili Hospital – Brescia, P.le Spedali Civili 1 –, 25123 Brescia, Italy
| | - Luca Triggiani
- Radiation Oncology Department, University and Spedali Civili Hospital – Brescia, P.le Spedali Civili 1 –, 25123 Brescia, Italy
| | - Sara Pedretti
- Radiation Oncology Department, University and Spedali Civili Hospital – Brescia, P.le Spedali Civili 1 –, 25123 Brescia, Italy
| | - Federica Saiani
- Medical Physics, Spedali Civili Hospital – Brescia, P.le Spedali Civili 1 –, 25123 Brescia, Italy
| | - Alfredo Fiume
- Medical Physics, Spedali Civili Hospital – Brescia, P.le Spedali Civili 1 –, 25123 Brescia, Italy
| | - Diana Greco
- Radiation Oncology Department, University and Spedali Civili Hospital – Brescia, P.le Spedali Civili 1 –, 25123 Brescia, Italy
| | - Stefano Ciccarelli
- Radiation Oncology Department, University and Spedali Civili Hospital – Brescia, P.le Spedali Civili 1 –, 25123 Brescia, Italy
| | - Alessia Polonini
- Medical Physics, Spedali Civili Hospital – Brescia, P.le Spedali Civili 1 –, 25123 Brescia, Italy
| | - Renzo Moretti
- Medical Physics, Spedali Civili Hospital – Brescia, P.le Spedali Civili 1 –, 25123 Brescia, Italy
| | - Stefano Maria Magrini
- Radiation Oncology Department, University and Spedali Civili Hospital – Brescia, P.le Spedali Civili 1 –, 25123 Brescia, Italy
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Delinikolas P, Patatoukas G, Kouloulias V, Dilvoi M, Plousi A, Efstathopoulos E, Platoni K. A novel Hemi-Body Irradiation technique using electron beams (HBIe -). Phys Med 2018. [PMID: 29519403 DOI: 10.1016/j.ejmp.2017.12.022] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/17/2022] Open
Abstract
PURPOSE Certain radiation responsive skin diseases may develop symptoms on the upper or the lower half of the body. The concept of a novel Hemi-Body Electron Irradiation (HBIe-) technique, described in this work, provides a low cost, LINAC based, intermediate treatment option in between extremely localized and Total Skin irradiation techniques. MATERIALS AND METHODS The HBIe- technique, developed in our department, incorporates a custom crafted treatment chamber equipped with adjustable Pb shielding and a single electron beam in extended Source-Skin Distance (SSD) setup. The patient is positioned in 'Stanford' technique positions. The geometrical setup provides both optimal dose homogeneity and dose deposition up to a depth of 2 cm. To confirm this, the following characteristics were measured and evaluated: a) percentage depth dose (PDD) on the treatment plane produced by a single electron beam at perpendicular incidence for six fields at 'Stanford' angles, b) 2D profile of the entrance dose on the treatment plane produced by a single field and c) the total surface dose on an anthropomorphic phantom delivered by all 6 fields. RESULTS The resulting homogeneity of the surface dose in the treatment plane for an average patient was 5-6%, while surface dose homogeneity on the anthropomorphic phantom was 7% for both the upper and the lower HBIe- variants. The total PDD exhibits an almost linear decrease to a practical range of 2 g/cm2. CONCLUSION In conclusion, HBIe- was proven effective in delivering the prescribed dose to the target area, while protecting the healthy skin.
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Affiliation(s)
- Panagiotis Delinikolas
- 2nd Department of Radiology, Radiotherapy Unit, ATTIKON Hospital, University of Athens School of Medicine, Greece; Space Radiobiology Research, Physics Department, Strathclyde University, Glasgow, UK.
| | - Georgios Patatoukas
- 2nd Department of Radiology, Radiotherapy Unit, ATTIKON Hospital, University of Athens School of Medicine, Greece
| | - Vasilios Kouloulias
- 2nd Department of Radiology, Radiotherapy Unit, ATTIKON Hospital, University of Athens School of Medicine, Greece
| | - Maria Dilvoi
- 2nd Department of Radiology, Radiotherapy Unit, ATTIKON Hospital, University of Athens School of Medicine, Greece
| | - Agapi Plousi
- 2nd Department of Radiology, Radiotherapy Unit, ATTIKON Hospital, University of Athens School of Medicine, Greece
| | - Efstathios Efstathopoulos
- 2nd Department of Radiology, Radiotherapy Unit, ATTIKON Hospital, University of Athens School of Medicine, Greece
| | - Kalliopi Platoni
- 2nd Department of Radiology, Radiotherapy Unit, ATTIKON Hospital, University of Athens School of Medicine, Greece
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Primary cutaneous non-Hodgkin lymphoma: results of a retrospective analysis in the light of the recent ILROG guidelines. TUMORI JOURNAL 2018; 104:394-400. [PMID: 28218382 DOI: 10.5301/tj.5000606] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
PURPOSE: To analyze clinical outcome, local response, survival and toxicity in patients with primary cutaneous lymphoma (PCL) treated with radiotherapy. METHODS: From 1995 to 2014, 112 patients were treated. B-cell lymphomas (CBCLs; n = 86) and T-cell lymphomas (CTCLs; n = 23) were analyzed separately. Clinical and therapeutic characteristics (age, sex, histology, primary treatment and radiotherapy modality) were related to response to treatment, survival and toxicity. RESULTS: CBCLs were divided into 4 subgroups: marginal-zone lymphoma (n = 20), follicle center lymphoma (n = 32), diffuse large-cell lymphoma (DLBCL; n = 22) and DLBCL-leg type (n = 12). No significant correlation was found between doses and systemic treatments, extent of biopsy and number of lesions. DLBCL-leg type patients were older (p = 0.05), had disseminated disease (p = 0.034), and more frequently had local (p = 0.01) or systemic recurrence (p = 0.05). CTCLs were divided into 4 subgroups: α/β CTCL (n = 3), nasal type CTCL (n = 0), γ/δ CTCL (n = 10) and mycosis fungoides (n = 10). Longer disease-free survival was observed in patients obtaining complete remission (p<0.001). CONCLUSIONS: Radiotherapy is feasible, safe and effective for localized PCLs. The choice of dose is related to histological subgroups and the related prognoses. Survival results are very good also in relapsing disease. In advanced cutaneous lymphoma radiotherapy alone has mainly a role in symptom palliation.
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Piotrowski T, Fundowicz M, Pawlaczyk M. Total Skin Electron Beam Therapy with Rotary Dual Technique as Palliative Treatment for Mycosis Fungoides. ACTA ACUST UNITED AC 2018; 32:517-522. [PMID: 29695554 DOI: 10.21873/invivo.11269] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2018] [Revised: 02/26/2018] [Accepted: 02/27/2018] [Indexed: 02/08/2023]
Abstract
BACKGROUND/AIM The aim of the study was to retrospectively assess the efficacy and toxicity of total skin electron beam therapy (TSEBT) in patients with primary cutaneous T-cell lymphoma (MF, mycosis fungoides) at various stages of development. PATIENTS AND METHODS Treatment results of 40 patients with MF stage IB-III, treated between 2001 and 2015, were reviewed. Median total dose was 32 Gy, delivered to the entire skin surface. Median follow-up was 60 months. RESULTS Clinical complete response was documented in 29 and partial response in 11 patients. The clinical response significantly influenced overall survival (OS) (p=0.002) and progression-free survival (PFS) (p<0.001). Mean OS was 76 months. Mean PFS was 48.9 months and current one- and two-year PFS were 67.5% and 55%, respectively. A statistically significant correlation was found between partial and total remission time and stages of the lymphoma (p=0.015). CONCLUSION TSEBT is an efficient and well-tolerated palliative treatment for symptomatic primary cutaneous T-cell lymphoma.
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Affiliation(s)
- Tomasz Piotrowski
- Department of Electroradiology, Poznan University of Medical Sciences, Poznan, Poland .,Department of Medical Physics, Greater Poland Cancer Centre, Poznan, Poland
| | | | - Mariola Pawlaczyk
- Department of Geriatrics and Gerontology, Poznan University of Medical Sciences, Poznan, Poland
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15
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Ibanez-Rosello B, Bautista JA, Bonaque J, Perez-Calatayud J, Gonzalez-Sanchis A, Lopez-Torrecilla J, Brualla-Gonzalez L, Garcia-Hernandez T, Vicedo-Gonzalez A, Granero D, Serrano A, Borderia B, Solera C, Rosello J. Failure modes and effects analysis of total skin electron irradiation technique. Clin Transl Oncol 2017; 20:330-365. [PMID: 28779421 DOI: 10.1007/s12094-017-1721-3] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2017] [Accepted: 07/24/2017] [Indexed: 11/26/2022]
Abstract
PURPOSE Total skin electron irradiation (TSEI) is a radiotherapy technique which consists of an homogeneous body surface irradiation by electrons. This treatment requires very strict technical and dosimetric conditions, requiring the implementation of multiple controls. Recently, the Task Group 100 report of the AAPM has recommended adapting the quality assurance program of the facility to the risks of their processes. MATERIALS AND METHODS A multidisciplinary team evaluated the potential failure modes (FMs) of every process step, regardless of the management tools applied in the installation. For every FM, occurrence (O), severity (S) and detectability (D) by consensus was evaluated, which resulted in the risk priority number (RPN), which permitted the ranking of the FMs. Subsequently, all the management tools used, related to the TSEI process, were examined and the FMs were reevaluated, to analyze the effectiveness of these tools and to propose new management tools to cover the greater risk FMs. RESULTS 361 FMs were identified, 103 of which had RPN ≥80, initially, and 41 had S ≥ 8. Taking this into account the quality management tools FMs were reevaluated and only 30 FMs had RPN ≥80. The study of these 30 FMs emphasized that the FMs that involved greater risk were related to the diffuser screen placement and the patient's position during treatment. CONCLUSIONS The quality assurance program of the facility has been adapted to the risk of this treatment process, following the guidelines proposed by the TG-100. However, clinical experience continually reveals new FMs, so the need for periodic risk analysis is required.
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Affiliation(s)
- B Ibanez-Rosello
- Radiation Oncology Department, La Fe University and Polytechnic Hospital, Av. Fernando Abril Martorell 106, 46026, Valencia, Spain.
| | - J A Bautista
- Radiation Oncology Department, La Fe University and Polytechnic Hospital, Av. Fernando Abril Martorell 106, 46026, Valencia, Spain
| | - J Bonaque
- Radiation Oncology Department, La Fe University and Polytechnic Hospital, Av. Fernando Abril Martorell 106, 46026, Valencia, Spain
| | - J Perez-Calatayud
- Radiation Oncology Department, La Fe University and Polytechnic Hospital, Av. Fernando Abril Martorell 106, 46026, Valencia, Spain
- Unidad Mixta de Investigación en Radiofísica e Instrumentación Nuclear en Medicina (IRIMED), Instituto de Investigación Sanitaria La Fe (IIS-La Fe)-Universitat de Valencia (UV), 46026, Valencia, Spain
| | - A Gonzalez-Sanchis
- Radiation Oncology Department, ERESA, Hospital General Universitario, 46014, Valencia, Spain
| | - J Lopez-Torrecilla
- Radiation Oncology Department, ERESA, Hospital General Universitario, 46014, Valencia, Spain
| | - L Brualla-Gonzalez
- Medical Physics Department, ERESA, Hospital General Universitario, 46014, Valencia, Spain
| | - T Garcia-Hernandez
- Medical Physics Department, ERESA, Hospital General Universitario, 46014, Valencia, Spain
| | - A Vicedo-Gonzalez
- Medical Physics Department, ERESA, Hospital General Universitario, 46014, Valencia, Spain
| | - D Granero
- Medical Physics Department, ERESA, Hospital General Universitario, 46014, Valencia, Spain
| | - A Serrano
- Medical Physics Department, ERESA, Hospital General Universitario, 46014, Valencia, Spain
| | - B Borderia
- Medical Physics Department, ERESA, Hospital General Universitario, 46014, Valencia, Spain
| | - C Solera
- Medical Physics Department, ERESA, Hospital General Universitario, 46014, Valencia, Spain
| | - J Rosello
- Medical Physics Department, ERESA, Hospital General Universitario, 46014, Valencia, Spain
- Physiology Department, University of Valencia, 46010, Valencia, Spain
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Total Skin Electron Beam for Primary Cutaneous T-cell Lymphoma. Int J Radiat Oncol Biol Phys 2015; 93:1077-86. [DOI: 10.1016/j.ijrobp.2015.08.041] [Citation(s) in RCA: 56] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2015] [Revised: 07/26/2015] [Accepted: 08/22/2015] [Indexed: 11/22/2022]
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Nelligan R, Baldwin Z, Ostwald T, Tran T, Bailey M. ACPSEM ROSG TBE working group recommendations for quality assurance in total body electron irradiation. AUSTRALASIAN PHYSICAL & ENGINEERING SCIENCES IN MEDICINE 2015; 38:479-92. [PMID: 26341344 DOI: 10.1007/s13246-015-0371-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/02/2015] [Accepted: 08/20/2015] [Indexed: 11/25/2022]
Abstract
The Australasian College of Physical Scientists and Engineers in Medicine (ACPSEM) Radiation Oncology Specialty Group (ROSG) formed a series of working groups in 2011 to develop recommendations for guidance of radiation oncology medical physics practice within the Australasian setting. These recommendations are intended to provide guidance for safe work practices and a suitable level of quality control without detailed work instructions. It is the responsibility of the medical physicist to ensure that locally available equipment and procedures are sufficiently sensitive to establish compliance to these recommendations. The recommendations are endorsed by the ROSG, and have been subject to independent expert reviews. For the Australian readers, these recommendations should be read in conjunction with the Tripartite Radiation Oncology Reform Implementation Committee Quality Working Group: Radiation Oncology Practice Standards (2011), and Radiation Oncology Practice Standards Supplementary Guide (2011). This publication presents the recommendations of the ACPSEM ROSG Total Body Electron Irradiation Working Group and has been developed in alignment with other international associations. However, these recommendations should be read in conjunction with relevant national, state or territory legislation and local requirements, which take precedence over the ACPSEM recommendations. It is hoped that the users of this and other ACPSEM recommendations will contribute to the development of future versions through the Radiation Oncology Specialty Group of the ACPSEM. This document serves as a guideline for calibration and quality assurance of equipment used for TBE in Australasia.
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Affiliation(s)
- Raelene Nelligan
- Royal Adelaide Hospital, North Terrace, Adelaide, South Australia, 5000, Australia.
| | - Zoë Baldwin
- Cancer Care Services, Royal Brisbane and Women's Hospital, Herston, QLD, 4029, Australia.,Genesis Cancer Care, Mater Hospital, Crow's Nest, New South Wales, 2065, Australia
| | - Trish Ostwald
- Calvary Mater Newcastle, Waratah, NSW, 2298, Australia
| | - Thu Tran
- Barwon Health, University Hospital, Geelong, VIC, 3220, Australia
| | - Michael Bailey
- Illawarra Cancer Care Centre, Wollongong Hospital, Wollongong, NSW, 2500, Australia
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Chowdhary M, Kabbani AA, Rimtepathip P, Cole DA, Cohen DJ. Rapidly progressive stage IVB mycosis fungoides treated with low-dose total skin electron beam therapy. Onco Targets Ther 2015; 8:1597-601. [PMID: 26170695 PMCID: PMC4493984 DOI: 10.2147/ott.s87219] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
Mycosis fungoides (MF) is the most common subtype of primary cutaneous T-cell lymphoma. Normally, MF has an indolent course although patients can progress to an advanced disease state (stages IIB–IVB). Advanced-stage disease is typically aggressive, leaving patients with debilitating symptoms and a decreased quality of life. Moreover, advanced-stage MF often proves refractory to therapy and carries a very poor prognosis. Total skin electron beam (TSEB) therapy is a well-established and successful treatment for early stage MF; however, its efficacy dramatically decreases with advanced-stage disease. In fact, TSEB in advanced-stage MF is generally considered to be palliative. Current consensus guidelines recommend a dose of 30–36 Gy to be delivered in 8–10 weeks; however, limited studies exist to determine the ideal treatment in Stage IV MF. Herein, we describe a case of a 50-year-old male who developed rapidly progressive stage IVB (T3N3M1B0) MF and was treated with low-dose (24 Gy) TSEB over 8 weeks. The patient was not treated with any systemic therapy before starting TSEB due to the widespread nature and the speed of disease progression. Remarkably, our patient showed nearly complete (95%) response of his MF with no apparent side effects from radiation. Furthermore, he has remained in remission over 4 years, requiring only a small boost to a few “shadowed” areas. Our case illustrates the benefit of using TSEB in stage IV MF. Additionally, our experience shows that low-dose TSEB can occasionally be efficacious in stage IV disease.
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Affiliation(s)
- Mudit Chowdhary
- Division of Dermatology, Department of Internal Medicine, Mercer University School of Medicine, Macon, GA, USA ; Division of Radiation Oncology, Department of Radiology, Mercer University School of Medicine, Macon, GA, USA
| | - Ahmad A Kabbani
- Division of Dermatology, Department of Internal Medicine, Mercer University School of Medicine, Macon, GA, USA
| | - Parin Rimtepathip
- Division of Dermatology, Department of Internal Medicine, Mercer University School of Medicine, Macon, GA, USA
| | - David A Cole
- Division of Radiation Oncology, Department of Radiology, Mercer University School of Medicine, Macon, GA, USA
| | - David J Cohen
- Division of Dermatology, Department of Internal Medicine, Mercer University School of Medicine, Macon, GA, USA
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Piotrowski T. Total skin electron irradiation-The technique where the electron beams are still irreplaceable. Rep Pract Oncol Radiother 2014; 19:69-71. [PMID: 24936323 DOI: 10.1016/j.rpor.2013.11.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022] Open
Affiliation(s)
- Tomasz Piotrowski
- Medical Physics Department, Greater Poland Cancer Centre, Poznan, Poland ; Electroradiology Department, University of Medical Sciences, Poznan, Poland
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