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Purnak S, Hosing C, Dabaja B, Bassett RL, Huen A, Duvic M. On the Way to Curing Advanced-Stage Mycosis Fungoides/Sézary Syndrome. CLINICAL LYMPHOMA, MYELOMA & LEUKEMIA 2024:S2152-2650(24)00268-4. [PMID: 39107202 DOI: 10.1016/j.clml.2024.07.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/10/2024] [Revised: 07/05/2024] [Accepted: 07/11/2024] [Indexed: 08/09/2024]
Abstract
INTRODUCTION/BACKGROUND Advanced-stage mycosis fungoides (MF) and Sézary syndrome (SS) have poor prognosis with median survivals of less than 5 years. Although a variety of treatments are approved for MF/SS patients, durable complete remissions (CR) are rare. PATIENTS AND METHODS Advanced-stage MF or SS patients who achieved CR and maintained in CR or stage IA for more than 10 years were identified by a retrospective search of the principal investigator's database. RESULTS Of 2266 patients diagnosed with MF or SS, 23 patients with advanced-stage MF/SS (6 IIB, 1 IIIB, 5 IVA1, 3 IVA2, 8 IVB) who achieved CR and maintained in CR or stage IA for ≥ 10 years were identified. As final/curative treatment, 11 patients underwent allogeneic stem cell transplantation (SCT). Most patients presented at young age, underwent SCT with reduced intensity conditioning regimen, had matched related donors, and controllable post-transplant graft versus host disease. Eleven patients were treated with TSEB as part of combined modality protocol in 2 patients and debulking therapy before allogeneic SCT in 9 patients. Five stage IIB patients achieved CR with radiotherapy. Four patients with blood involvement were treated with extracorporeal photopheresis (ECP) in combination with long-term antibiotics and immunomodulatory agents. Long-term antibiotics were given to 14 patients. CONCLUSION TSEB followed by allogeneic SCT, radiotherapy, ECP plus long-term antibiotics and immunomodulatory agents were the most common curative/final treatments found in our patients. We are reporting the details of our long-term complete responders' treatment course in the hopes of obtaining more cure responses in the future.
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Affiliation(s)
- Seda Purnak
- Department of Dermatology, The University of Texas MD Anderson Cancer Center, Houston, TX.
| | - Chitra Hosing
- Department of Stem Cell Transplantation, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Bouthaina Dabaja
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Roland L Bassett
- Department of Biostatistics, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Auris Huen
- Department of Dermatology, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Madeleine Duvic
- Department of Dermatology, The University of Texas MD Anderson Cancer Center, Houston, TX
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Kashabano JJ, Rugengamazi E, Matiku SB, Mruma RM, Lugina EL. Mycosis fungoides with spongiosis: a case report. J Med Case Rep 2023; 17:458. [PMID: 37919795 PMCID: PMC10623773 DOI: 10.1186/s13256-023-04188-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2023] [Accepted: 09/20/2023] [Indexed: 11/04/2023] Open
Abstract
BACKGROUND Mycosis fungoides (MF) is the most common form of cutaneous T-cell lymphoma (CTCL). CTCL are an uncommon, heterogeneous group of non-Hodgkin lymphomas (NHLs) of T- and B-cell origin where the skin is the primary organ of involvement. It is characterized by malignant CD4+ T-cells infiltrating the skin and other organs, leading to progressive skin and systemic involvement. Histopathologically, MF is characterized by atypical lymphocytes demonstrating epidermotropism without spongiosis. Spongiosis is the histological hallmark of intercellular epidermal edema, viewed as clear spaces within the epidermis, and is very common in benign inflammatory dermatoses. Very few studies have reported MF in sub-Saharan Africa (SSA). We are reporting a case of MF with a rare presentation of spongiosis treated successfully with a low dose total skin electron beam therapy (TSEBT) followed by maintenance therapy of low dose Methotrexate (MT) at the Ocean Road Cancer Institute (ORCI) in Tanzania. This is the first case of MF to be managed with low-dose TSEBT in Tanzania. The authors wish to create awareness of the disease among physicians and pathologists and expand on the data paucity in SSA. CASE DESCRIPTION We are reporting a case of a 31-year-old male of African origin who self-referred to our oncology center with a 4-year history of skin rashes throughout the body, which was unresponsive to topical steroid treatment. The biopsy was taken, and the patient was diagnosed with MF CD 3 positive with spongiosis. The patient was treated with radiotherapy, whereby he received low dose total skin electron beam therapy (TSEBT) 12 Gy in 3 fractions at a daily dose of 4 Gy, followed by maintenance therapy of low dose Methotrexate and attained an excellent therapeutic response. CONCLUSION Spongiosis is an infrequent presentation of MF. Low-dose TSEBT provides reliable and rapid reduction of disease burden in patients with MF, which could be administered safely multiple times during a patient's disease with an acceptable toxicity profile. Lack of tendency to perform skin biopsies and cost constraints in assessing multiple immunophenotypic markers lead to missing the diagnosis. Diagnosis and treatment of MF in resource-limited countries is challenging.
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Affiliation(s)
- Jesse Jonathan Kashabano
- Department of Clinical Oncology, Muhimbili University of Health and Allied Sciences, Dar Es Salaam, Tanzania.
- Benjamin Mkapa Hospital, Dodoma, Tanzania.
| | - Eulade Rugengamazi
- Department of Clinical Oncology, Muhimbili University of Health and Allied Sciences, Dar Es Salaam, Tanzania
| | - Subira Bhoke Matiku
- Department of Pathology, Muhimbili University of Health and Allied Sciences, Dar Es Salaam, Tanzania
| | - Rashid Mussa Mruma
- Department of Clinical Oncology, Muhimbili University of Health and Allied Sciences, Dar Es Salaam, Tanzania
- Ocean Road Cancer Institute, Dar Es Salaam, Tanzania
| | - Emmanuel L Lugina
- Department of Clinical Oncology, Muhimbili University of Health and Allied Sciences, Dar Es Salaam, Tanzania
- Ocean Road Cancer Institute, Dar Es Salaam, Tanzania
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Vitiello P, Sagnelli C, Ronchi A, Franco R, Caccavale S, Mottola M, Pastore F, Argenziano G, Creta M, Calogero A, Fiorelli A, Casale B, Sica A. Multidisciplinary Approach to the Diagnosis and Therapy of Mycosis Fungoides. Healthcare (Basel) 2023; 11:healthcare11040614. [PMID: 36833148 PMCID: PMC9957453 DOI: 10.3390/healthcare11040614] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2023] [Revised: 02/10/2023] [Accepted: 02/15/2023] [Indexed: 02/22/2023] Open
Abstract
Mycosis fungoides is the most common primary cutaneous T-cell lymphoma, characterized by skin-homing CD4+ T cells derivation, indolent course, and low-grade of malignancy. Mycosis fungoides's classic type typically onsets with cutaneous erythematous patches, plaque, and tumor. In WHO-EORTC classification, folliculotropic mycosis fungoides, pagetoid reticulosis, and granulomatous slack skin are recognized as distinct variants of mycosis fungoides, because of their clinical and histological features, behavior, and /or prognosis. Mycosis fungoides often shows diagnostic difficulties, due to its absence of specific features and lesional polymorphism. A patient's treatment requires staging. In about 10% of cases, mycosis fungoides can progress to lymph nodes and internal organs. Prognosis is poor at advanced stage and management needs a multidisciplinary team approach. Advanced stage disease including tumors, erythroderma, and nodal, visceral, or blood involvement needs skin directed therapy associated with systemic drugs. Skin directed therapy includes steroids, nitrogen mustard, bexarotene gel, phototherapy UVB, and photochemiotherapy, i.e., total skin electron radiotherapy. Systemic therapies include retinoids, bexarotene, interferon, histone deacetylase inhibitors, photopheresis, targeted immunotherapy, and cytotoxic chemotherapy. Complexity of mycosis fungoides associated with long-term chronic evolution and multiple therapy based on disease stage need a multidisciplinary team approach to be treated.
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Affiliation(s)
- Paola Vitiello
- Dermatology Unit, University of Campania Luigi Vanvitelli, 80131 Naples, Italy
| | - Caterina Sagnelli
- Department of Mental Health and Public Medicine, University of Campania Luigi Vanvitelli, 80131 Naples, Italy
- Correspondence: ; Tel.: +39-39-3810-7860
| | - Andrea Ronchi
- Pathology Unit, Department of Mental and Physical Health and Preventive Medicine, University of Campania Luigi Vanvitelli, 80131 Naples, Italy
| | - Renato Franco
- Pathology Unit, Department of Mental and Physical Health and Preventive Medicine, University of Campania Luigi Vanvitelli, 80131 Naples, Italy
| | - Stefano Caccavale
- Dermatology Unit, University of Campania Luigi Vanvitelli, 80131 Naples, Italy
| | - Maria Mottola
- Department of Heart Surgery and Transplantations, AORN Dei Colli-V Monaldi, 80131 Naples, Italy
| | | | - Giuseppe Argenziano
- Dermatology Unit, University of Campania Luigi Vanvitelli, 80131 Naples, Italy
| | - Massimiliano Creta
- Department of Neurosciences, Reproductive Sciences and Odontostomatology, University of Naples Federico II, 80131 Naples, Italy
| | - Armando Calogero
- Department of Advanced Biomedical Sciences, University of Naples Federico II, 80131 Naples, Italy
| | - Alfonso Fiorelli
- Thoracic Surgery Unit, University of Campania Luigi Vanvitelli, 80131 Naples, Italy
| | - Beniamino Casale
- Department of Pneumology and Tisiology, AO Dei Colli-V. Monaldi, 80131 Naples, Italy
| | - Antonello Sica
- Department of Precision Medicine, University of Campania Luigi Vanvitelli, 80131 Naples, Italy
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Fay CJ, Awh KC, LeBoeuf NR, Larocca CA. Harnessing the immune system in the treatment of cutaneous T cell lymphomas. Front Oncol 2023; 12:1071171. [PMID: 36713518 PMCID: PMC9878398 DOI: 10.3389/fonc.2022.1071171] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2022] [Accepted: 12/01/2022] [Indexed: 01/15/2023] Open
Abstract
Cutaneous T cell lymphomas are a rare subset of non-Hodgkin's lymphomas with predilection for the skin with immunosuppressive effects that drive morbidity and mortality. We are now appreciating that suppression of the immune system is an important step in the progression of disease. It should come as no surprise that therapies historically and currently being used to treat these cancers have immune modulating functions that impact disease outcomes. By understanding the immune effects of our therapies, we may better develop new agents that target the immune system and improve combinatorial treatment strategies to limit morbidity and mortality of these cancers. The immune modulating effect of therapeutic drugs in use and under development for cutaneous T cell lymphomas will be reviewed.
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Radiotherapie kutaner Lymphome. DIE DERMATOLOGIE 2022; 73:772-781. [PMID: 36018330 PMCID: PMC9412812 DOI: 10.1007/s00105-022-05046-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Accepted: 07/20/2022] [Indexed: 11/19/2022]
Abstract
Hintergrund Primär kutane Lymphome (KL) sind sehr strahlenempfindlich. Deshalb ist die Strahlentherapie ein integraler Bestandteil der multimodalen Behandlung. Ziel der Arbeit Die vorliegende Arbeit ermöglicht einen Überblick über Indikationen, Entwicklungen der Techniken und Dosiskonzepte der Ganzhautelektronenbestrahlung (TSEBT), der lokalen Radiatio sowie Erhaltungstherapien und aktuelle Kombinationsstudien kutaner T‑ und B‑Zell-Lymphome. Material und Methoden Es erfolgte eine selektive Literaturrecherche über die Datenbank PubMed zur Radiotherapie der KL, eine Recherche aktueller Studien mittels clinicaltrials.gov, Darstellung interner Behandlungsstrategien sowie Zusammenfassung der nationalen und internationalen Leitlinien. Ergebnisse Die Niedrigdosis-TSEBT wird als Alternative zur konventionellen 36-Gy-TSEBT national und international empfohlen. Die wichtigsten Vorteile sind die bessere Verträglichkeit, die Möglichkeit der Wiederholung, ein verkürzter Verlauf (ca. 3 Wochen) und eine kurze Dauer bis zum Ansprechen. In den aktuellen Studien wird die TSEBT in der Regel mit 12 Gy durchgeführt und mit unterschiedlichen Immuntherapeutika und epigenetischen Regulatoren kombiniert. Die lokale Radiatio ist indiziert bei Tumoren der Mycosis fungoides und ein kuratives Behandlungsschema für andere KL, insbesondere bei primär kutanen B‑Zell-Lymphomen. Diskussion Die TSEBT ist eine sehr effektive Behandlungsoption der Mycosis fungoides (MF) und bietet einen wichtigen palliativen Nutzen, da sie zügig zur Symptomlinderung und Verbesserung der Lebensqualität führt. Sie ist eine wichtige Behandlungsoption, insbesondere bei Patienten mit ausgeprägten generalisierten Plaques oder im Tumorstadium. Die lokale Radiatio wird im Rahmen der TSEBT für Tumoren und Aufsättigung unterversorgter Areale eingesetzt. Andere KL sind primär kurativ mit einer lokalen Radiatio behandelbar.
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Gao Y, Hou X, Dai Y, Yang T, Chen K. Radiation-induced FAP + fibroblasts are involved in keloid recurrence after radiotherapy. Front Cell Dev Biol 2022; 10:957363. [PMID: 36092734 PMCID: PMC9449371 DOI: 10.3389/fcell.2022.957363] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2022] [Accepted: 08/04/2022] [Indexed: 12/04/2022] Open
Abstract
Background: Keloid scars (KSs), which are composed of abnormal hyperplastic scar tissue, form during skin wound healing due to excessive fibroblast activation and collagen secretion. Although surgical resection and radiation therapy are used to prevent recurrence, KS recurrence rates range from 15 to 23%, and the underlying mechanism is unclear. Methods: To elucidate the mechanism of keloid recurrence, we established a PDX model and the grafts remained for over 20 weeks after transplantation on the bilateral backs of the NCG mice. Results: RNA-seq revealed that KS tissue gene expression was highly consistent before and after transplantation. Then, one side of the KS graft was irradiated with electron beam therapy (10 Gy), significant increases in vimentin and fibroblast activation protein alpha (FAP) expression were observed after irradiation and were accompanied by severe microvascular destruction. Surprisingly, 4 weeks after irradiation, significantly increased recurrence was observed with increased FAP + tissue and cell cycle regulator expression, resulting in a remarkable altered graft volume. Moreover, irradiation-induced FAP upregulation markedly facilitated radiation resistance and increased cell cycle progression, decreased senescence, and increased energy production. Conclusion: Our findings revealed that irradiation causes increased abundance of FAP + cells, which was associated with cell proliferation and delayed cellular senescence, accompanied by ATP production.
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Affiliation(s)
- Yan Gao
- Department of Radiation Oncology and Therapy, The First Hospital of Jilin University, Changchun, China
| | - Xue Hou
- Department of Radiation Oncology and Therapy, The First Hospital of Jilin University, Changchun, China
| | - Yuyin Dai
- Department of Nuclear Medicine, The First Hospital of Jilin University, Changchun, China
| | - Ting Yang
- Laboratory of Cancer Precision Medicine, The First Hospital of Jilin University, Changchun, China
| | - Kexin Chen
- Institute of Translational Medicine, The First Hospital of Jilin University, Changchun, China
- *Correspondence: Kexin Chen,
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7
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Canu D, Pham-Ledard A, Ouhabrache N, Beylot-Barry M. Changes in total skin electron beam therapy modalities for mycosis fungoides: A single-centre study. Ann Dermatol Venereol 2022; 149:180-184. [PMID: 35595588 DOI: 10.1016/j.annder.2022.02.006] [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: 09/04/2021] [Revised: 10/20/2021] [Accepted: 02/16/2022] [Indexed: 11/25/2022]
Abstract
BACKGROUND Mycosis fungoides (MF) is a highly radiosensitive disease. Total skin electron beam therapy (TSEBT) is an effective option that may allow prolonged response for several months. Recently, a low-dose regimen (12 Gy) has been reported more frequently, with less complete response than for standard doses (36 Gy) but better safety. Our aim was to compare patients treated with 12-Gy and 36-40-Gy TSEBT regimens at our centre for efficacy and safety. METHODS This retrospective, monocentric study in Bordeaux University Hospital included all MF patients treated with 12-Gy or 36-40-Gy TSEBT between 2011 and 2020. RESULTS Patients presented with MF at the following stages: 15 T2, including 9 folliculotropic MF; 2 T3, including 1 folliculotropic; 8 T4, including 2 Sézary syndromes. The mean follow-up time after TSEBT was 43.5 months [range: 2-128] for the 36-40-Gy group and 25.2 months [range: 4-45] for the 12-Gy group. The 3-month overall response rate (ORR) was similar for both groups (84.6% for 36-40 Gy and 91.7% for 12 Gy), but there was a tendency to more complete response in the 36-40-Gy group (30.8% vs 8.3%, P=0.35). Progression-free survival (PFS) tended to be better in the 36-40-Gy group than in the low-dose group (15.7 months vs 5.3 months; P=0.28). Patients treated with low-dose TSEBT had a lower incidence of radiation dermatitis (16.7% vs 38.4%, P=0.42). CONCLUSION We confirm that TSEBT is an effective option, including at lower doses. Differences between low- and standard-dose regimens were not significant in our series. Although a low-dose regimen seemed to result in lower complete response and long-term efficacy rates in comparison with a standard dose, treatment at lower doses presents the advantage of repeatability, with fewer and weaker side effects, in the event of disease recurrence. Second-line treatments were mostly skin-directed in this group.
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Affiliation(s)
- D Canu
- Department of Dermatology, Hôpital Saint-André, CHU de Bordeaux, 33000 Bordeaux, France
| | - A Pham-Ledard
- Department of Dermatology, Hôpital Saint-André, CHU de Bordeaux, 33000 Bordeaux, France; Inserm, U 1312, Translational Research on Oncodermatology and Orphean skin diseases, BRIC, University of Bordeaux, RIC - UMR, 33000 Bordeaux, France
| | - N Ouhabrache
- Department of Radiotherapy, Hôpital Haut-Lévêque, CHU de Bordeaux, 33600 Pessac, France
| | - M Beylot-Barry
- Department of Dermatology, Hôpital Saint-André, CHU de Bordeaux, 33000 Bordeaux, France; Inserm, U 1312, Translational Research on Oncodermatology and Orphean skin diseases, BRIC, University of Bordeaux, RIC - UMR, 33000 Bordeaux, France.
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Smits K, Quint K, Vermeer M, Daniëls L, Willemze R, Jansen P, Jansen W, Neelis K. Total skin electron beam therapy for cutaneous T-cell lymphomas in the Netherlands: A retrospective analysis of treatment outcomes and selection for high or low dose schedule. Clin Transl Radiat Oncol 2022; 33:77-82. [PMID: 35106383 PMCID: PMC8787769 DOI: 10.1016/j.ctro.2021.12.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2021] [Revised: 12/03/2021] [Accepted: 12/05/2021] [Indexed: 10/25/2022] Open
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Rahimy E, Skinner L, Kim YH, Hoppe RT. Technical report: 3D-printed patient-specific scalp shield for hair preservation in total skin electron beam therapy. Tech Innov Patient Support Radiat Oncol 2021; 18:12-15. [PMID: 33997322 PMCID: PMC8091539 DOI: 10.1016/j.tipsro.2021.03.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2021] [Revised: 03/04/2021] [Accepted: 03/23/2021] [Indexed: 12/14/2022] Open
Abstract
•Techniques for non-lead scalp-shielding in total skin therapy are lacking.•3D-printing is a promising technique for patient-specific conformal shielding.•We present a case of effective scalp shielding with 3D-printing.
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Affiliation(s)
- Elham Rahimy
- Department of Radiation Oncology, Stanford University, Stanford, CA, USA
| | - Lawrie Skinner
- Department of Radiation Oncology, Stanford University, Stanford, CA, USA
| | - Youn H Kim
- Department of Dermatology, Stanford University, Stanford, CA, USA
| | - Richard T Hoppe
- Department of Radiation Oncology, Stanford University, Stanford, CA, USA
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Nonmyeloablative allogeneic transplantation achieves clinical and molecular remission in cutaneous T-cell lymphoma. Blood Adv 2021; 4:4474-4482. [PMID: 32941647 DOI: 10.1182/bloodadvances.2020001627] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2020] [Accepted: 08/13/2020] [Indexed: 02/08/2023] Open
Abstract
The majority of patients with refractory, advanced-stage mycosis fungoides (MF) or Sézary syndrome (SS) have a life expectancy of <5 years. Here, we report a phase 2 study of a novel nonmyeloablative allogeneic transplantation strategy tailored for this patient population. This study has completed the enrollment, and 35 patients (13 MF, 22 SS) have undergone transplant as planned. The majority (80%) of the patients had stage IV disease and received multiple previous systemic therapies. All patients had active disease at the time of conditioning using total skin electron beam therapy, total lymphoid irradiation, and antithymocyte globulin, and received allograft infusion as outpatients. Cyclosporine or tacrolimus and mycophenolate mofetil were used for graft-versus-host disease (GVHD) prophylaxis. Patients tolerated the transplant well, with 1- and 2-year nonrelapse mortality of 3% and 14%, respectively. The day +180 cumulative incidence of grade 2 to 4 acute GVHD was 16%, and the 2-year incidence of moderate/severe chronic GVHD was 32%. With a median posttransplant follow-up of 5.4 years, the 2-, 3-, and 5-year overall survival rates were 68%, 62%, and 56%. Using high-throughput sequencing of the T-cell receptor for minimal residual disease monitoring, we observed that 43% achieved molecular remission, which was associated with a lower incidence of disease progression or relapse (9% vs 87%; P = .02). Our study also showed that patients who were aged ≥65 years at the time of allotransplant had similar clinical outcomes compared with younger patients. Thus, we have developed an alternative and potentially curative nonmyeloablative allogeneic transplant regimen for patients with advanced stage MF/SS. This trial was registered at www.clinicaltrials.gov as #NCT00896493.
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Cutaneous Lymphomas — Part I: Mycosis Fungoides, Sézary Syndrome, and CD30+ Cutaneous Lymphoproliferative Disorders. ACTAS DERMO-SIFILIOGRAFICAS 2021. [DOI: 10.1016/j.adengl.2020.12.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
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12
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Pujol R, Gallardo F. Linfomas cutáneos. Parte I: micosis fungoide, síndrome de Sézary y proliferaciones linfoides cutáneas CD30 positivas. ACTAS DERMO-SIFILIOGRAFICAS 2021; 112:14-23. [DOI: 10.1016/j.ad.2020.08.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2020] [Revised: 08/13/2020] [Accepted: 08/22/2020] [Indexed: 12/11/2022] Open
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13
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Georgakopoulos I, Papadavid E, Platoni K, Kougioumtzopoulou A, Patatoukas G, Kypraiou E, Nikolaou V, Efstathopoulos E, Kelekis N, Kouloulias V. Low dose total skin electron beam therapy for the management of T cell cutaneous lymphomas. Dermatol Ther 2020; 33:e13478. [PMID: 32391976 DOI: 10.1111/dth.13478] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2020] [Revised: 04/21/2020] [Accepted: 04/23/2020] [Indexed: 11/28/2022]
Abstract
Mycosis fungoides (MF) represent the most common type of primary cutaneous lymphomas. Total skin electron beam (TSEB) therapy to a total skin administered dose of 36 Gy represents a very effective treatment regimen and its role in the management of MF is well established. Unfortunately, the issue in MF is that despite the proved effectiveness of radiation therapy, disease regress, and the main goal of TSEB treatment seems to be the prolongation of the overall response duration time. Taking into consideration the high radio-sensitivity of the disease, lower radiation doses have been tested with acceptable and comparable results. We prospectively analyzed low dose TSEB in 14 patients treated at ATTIKON University Hospital from 2011 to 2017. After a median duration of follow up time of 39 months we found that low dose TSEB is an effective treatment option, since therapeutic results are more than acceptable, with minimal toxicity. The fact that it can be repeated safely in the natural course of a "regressive" disease makes it more attractive than the standard full dose scheme of 36 Gy.
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Affiliation(s)
- Ioannis Georgakopoulos
- 2nd Department of Radiology, Radiotherapy Unit, National and Kapodistrian University of Athens, Medical School, ATTIKON University Hospital, Athens, Greece
| | - Evangelia Papadavid
- 2nd Dermatologic Clinic, ATTIKON University Hospital, National and Kapodistrian University of Athens, Medical School, Athens, Greece
| | - Kalliopi Platoni
- 2nd Department of Radiology, Radiotherapy Unit, National and Kapodistrian University of Athens, Medical School, ATTIKON University Hospital, Athens, Greece
| | - Amdromachi Kougioumtzopoulou
- 2nd Department of Radiology, Radiotherapy Unit, National and Kapodistrian University of Athens, Medical School, ATTIKON University Hospital, Athens, Greece
| | - George Patatoukas
- 2nd Department of Radiology, Radiotherapy Unit, National and Kapodistrian University of Athens, Medical School, ATTIKON University Hospital, Athens, Greece
| | - Efrosyni Kypraiou
- 2nd Department of Radiology, Radiotherapy Unit, National and Kapodistrian University of Athens, Medical School, ATTIKON University Hospital, Athens, Greece
| | - Vasiliki Nikolaou
- 1st Dermatology Clinic, Syggros Hospital, National Kapodistrian University of Athens, Medical School, Athens, Greece
| | - Efstathios Efstathopoulos
- 2nd Department of Radiology, Radiotherapy Unit, National and Kapodistrian University of Athens, Medical School, ATTIKON University Hospital, Athens, Greece
| | - Nikolaos Kelekis
- 2nd Department of Radiology, Radiotherapy Unit, National and Kapodistrian University of Athens, Medical School, ATTIKON University Hospital, Athens, Greece
| | - Vasilios Kouloulias
- 2nd Department of Radiology, Radiotherapy Unit, National and Kapodistrian University of Athens, Medical School, ATTIKON University Hospital, Athens, Greece
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Total skin electron beam therapy for primary cutaneous T-cell lymphomas: clinical characteristics and outcomes in a Mexican reference center. Rep Pract Oncol Radiother 2020; 25:562-567. [PMID: 32494229 DOI: 10.1016/j.rpor.2020.03.020] [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: 10/05/2019] [Revised: 03/13/2020] [Accepted: 03/25/2020] [Indexed: 11/24/2022] Open
Abstract
Aim The aim of this study was to assess treatment modalities, treatment response, toxicity profile, disease progression and outcomes in 14 patients with a confirmed diagnosis of primary cutaneous T-cell lymphoma (PCTCL) treated with total skin electron beam therapy (TSEBT). Background Primary cutaneous lymphomas (PCLs) are extranodal non-Hodgkin lymphomas originating in the skin without evidence of extracutaneous disease at diagnosis. Despite advances in systemic and local therapy options, the management of advanced stages remains mostly palliative. Materials and Methods This is a retrospective study of patients with PCTCL, diagnosed and treated in a reference center in Mexico City, analyzing treatment modalities, response to treatment, long-term outcome, and mortality. Results Eight males (57%) and 6 (43%) females were identified. Most patients were stage IVA (n = 5, 36%) followed by stage IB and IIB (28.5% and 21.4%, respectively). Eleven patients received the low-dose RT scheme (12 Gy), 1 patient, the intermediate-dose RT scheme (24 Gy), and 2 patients, the conventional-dose RT scheme (36 Gy). Mean follow-up time was 4.6 years. At first follow-up examination, 6-8 weeks after radiotherapy, the overall response rate (ORR) for the cohort was 85%. The median PFS for the whole cohort was 6 months. Conclusion This study reinforces the role of TSEBT when compared with other treatment modalities and novel agents. Low-dose TSEBT is now widely used because of the opportunity for retreatment.
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Key Words
- CI, Confidence interval
- CR, Complete response
- Cutaneous lymphoma
- EORTC, European Organisation for Research and Treatment of Cancer
- LCT, Large cell transformation
- LPD, Lymphoproliferative disorder
- MF, Mycosis fungoides
- Mycosis fungoides
- NHL, Non-Hodgkin lymphomas
- ORR, Overall response rate
- OS, Overall survival
- PCL, Primary cutaneous lymphoma
- PCTCL, Primary cutaneous T-cell lymphomas
- PFS, Progression-free survival
- RT, Radiotherapy
- SD, Standard deviation
- SS, Sézary syndrome
- Sézary syndrome
- TSEBT, Total skin electron beam therapy
- Total skin electron beam therapy.
- UV, Ultraviolet
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15
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O'Malley JT, de Masson A, Lowry EL, Giobbie-Hurder A, LeBoeuf NR, Larocca C, Gehad A, Seger E, Teague JE, Fisher DC, Kupper TS, Devlin PM, Clark RA. Radiotherapy Eradicates Malignant T Cells and Is Associated with Improved Survival in Early-Stage Mycosis Fungoides. Clin Cancer Res 2019; 26:408-418. [PMID: 31636100 DOI: 10.1158/1078-0432.ccr-18-4147] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2018] [Revised: 04/23/2019] [Accepted: 10/09/2019] [Indexed: 01/02/2023]
Abstract
PURPOSE Mycosis fungoides is the most common subtype of cutaneous T-cell lymphoma. Skin-directed treatments often improve but do not cure mycosis fungoides skin lesions. The purpose of this study was to (i) assess whether remission was associated with malignant T-cell clone depletion at treated sites using either low-dose radiotherapy (LDRT, 8 Gy) or topical steroids and (ii) assess whether a clone-ablative therapy, like LDRT, is associated with overall survival in patients with high-risk early-stage CTCL. EXPERIMENTAL DESIGN Pre- and posttreatment biopsies from 20 lesional skin samples of 18 patients with mycosis fungoides who received either 8 Gy LDRT (n = 16) or topical steroids (n = 4) underwent high-throughput T-cell receptor sequencing of the TCRB gene to quantify the malignant T-cell clone. For the retrospective chart review, overall survival of 47 high-risk early-stage patients was compared between patients who did or did not receive radiation. RESULTS LDRT eradicated the clone in 5 of 16 lesions and reduced it >90% in 11 of 16; there were no recurrences in these lesions. Patients treated with topical steroids appeared to clinically improve, but the malignant clone persisted. We found that the number of residual malignant T cells predicted lesion recurrence. A retrospective review showed that early-stage high-risk patients who received radiation as part of their treatment regimen had prolonged overall survival compared with patients who did not. CONCLUSIONS These findings demonstrate that LDRT can eradicate malignant T cells in mycosis fungoides, provides robust disease control, and is associated with improved survival in high-risk early-stage patients.
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Affiliation(s)
- John T O'Malley
- Department of Dermatology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts.,Dana-Farber/Brigham and Women's Cancer Center (DF/BWCC), Boston, Massachusetts
| | - Adele de Masson
- Department of Dermatology, Saint-Louis Hospital, Paris, France
| | - Elizabeth L Lowry
- Department of Dermatology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts.,Dana-Farber/Brigham and Women's Cancer Center (DF/BWCC), Boston, Massachusetts
| | | | - Nicole R LeBoeuf
- Department of Dermatology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts.,Dana-Farber/Brigham and Women's Cancer Center (DF/BWCC), Boston, Massachusetts
| | - Cecilia Larocca
- Department of Dermatology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts.,Dana-Farber/Brigham and Women's Cancer Center (DF/BWCC), Boston, Massachusetts
| | - Ahmed Gehad
- Department of Dermatology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Edward Seger
- SUNY Downstate College of Medicine, Brooklyn, New York
| | - Jessica E Teague
- Department of Dermatology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - David C Fisher
- Dana-Farber/Brigham and Women's Cancer Center (DF/BWCC), Boston, Massachusetts
| | - Thomas S Kupper
- Department of Dermatology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts.,Dana-Farber/Brigham and Women's Cancer Center (DF/BWCC), Boston, Massachusetts
| | - Phillip M Devlin
- Department of Dermatology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts.,Department of Radiation Oncology, Dana Farber/Brigham and Women's Cancer Center, Harvard Medical School, Boston, Massachusetts
| | - Rachael A Clark
- Department of Dermatology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts. .,Dana-Farber/Brigham and Women's Cancer Center (DF/BWCC), Boston, Massachusetts
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16
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Abstract
Primary cutaneous lymphomas are the second most common form of extra-nodal lymphomas. They have special characteristics compared with other lymphomas. They are most frequently of T-cell origin and they generally have a much more indolent course than lymphomas of similar histology in other locations. Mycosis fungoides is the most common type of cutaneous lymphoma. Primary cutaneous lymphomas remain confined to the skin for a long time. Skin-directed therapies are the main treatments; systemic treatments are not very effective for the skin lesions. Skin-directed therapies used for the early and thin lesions are topical corticosteroids, phototherapy and topical retinoids and, for the more widespread or thick lesions, topical nitrogen mustard and radiation. Radiation therapy is highly effective and is indicated in virtually all cases of localised disease. Radiation therapy may be given to the whole skin surface, so-called total skin electron beam therapy. However, if the disease spreads to other organs, systemic treatments are indicated, often combined with skin-directed therapies. Conventional cytotoxic therapy is less effective in cutaneous lymphomas. The commonly used therapies, such as interferon, enhanced anti-tumour immunity and the recent advances in immune therapies may improve our treatments for cutaneous lymphomas.
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17
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Obeid JP, Gutkin PM, Lewis J, Skinner L, Wang EB, Khodadoust MS, Kim YH, Weng WK, Hoppe RT, Hiniker SM. Volumetric Modulated Arc Therapy and 3-Dimensional Printed Bolus in the Treatment of Refractory Primary Cutaneous Gamma Delta Lymphoma of the Bilateral Legs. Pract Radiat Oncol 2019; 9:220-225. [DOI: 10.1016/j.prro.2019.02.016] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2018] [Revised: 02/11/2019] [Accepted: 02/25/2019] [Indexed: 02/07/2023]
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18
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Multi-institutional Investigation: Circulating CD4:CD8 ratio is a prognosticator of response to total skin electron beam radiation in mycosis fungoides. Radiother Oncol 2019; 131:88-92. [PMID: 30773193 PMCID: PMC6662194 DOI: 10.1016/j.radonc.2018.12.003] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2018] [Revised: 11/27/2018] [Accepted: 12/01/2018] [Indexed: 11/21/2022]
Abstract
Background and purpose: A lower proportion of CD8+ tumor infiltrating lymphocytes in mycosis fungoides (MF) patients is associated with worse survival. However, it is not known whether circulating CD4:CD8 ratio is a prognosticator of response to total skin electron beam therapy (TSEBT). Methods and materials: We identified 126 MF patients treated with TSEBT from 2001 to 20014 at two high-volume academic centers. Circulating CD4:CD8 ratio was obtained within 1 week before TSEBT. TSEBT was delivered with 6–9mEV electrons with low (12 Gy) or conventional (≥12 Gy) doses. Treatment response was assessed with the modified Severity Weighted Assessment Tool (mSWAT). Post-treatment mSWAT decrease of ≥75% was classified as near complete response (CR) while mSWAT decrease of <75% was considered partial response (PR). Receiver operating characteristic analysis determined an optimal CD4:CD8 threshold value to predict TSEBT response in the derivation cohort and was applied to an external validation cohort. Results: 71.4% and 28.6% of patients achieved CR and PR after TSEBT. Higher CD4:CD8 ratio predicted poorer response: median CD4:CD8 in patients with PR vs. CR was 4.84 vs. 1.97 (p = 0.002). A threshold CD4:CD8 of 4.42 optimally discriminated in the discovery cohort patients with PR vs. XR (sensitivity 90%, specificity 59%, area under curve (AUC) = 0.71; p = 0.002). Within an independent test cohort (n = 32), 73.9% of patients with CD4:CD8 <4.42 achieved CR vs. 33.3% of those with CD4:CD8 ≥4.42 (p = 0.033). Among all patients with CD4:CD8 <4.42 (n = 73), 74% achieved CR with low-dose TSEBT vs. 93% with conventional dose TSEBT (p = 0.02). On multivariable logistic regression, CD4:CD8 remained a significant independent predictor of TSEBT response in all patients (OR = 0.107, 95% CI 0.395–0.290, p < 0.001). Conclusion: Peripheral blood CD4:CD8 ratio was a significant independent predictor of TSEBT response of MF patients as validated in an independent cohort at separate academic center. The potential for CD4: CD8 ratio as a biomarker to inform radiation treatment dosing warrants further investigation.
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19
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Georgakopoulos I, Papadavid E, Platoni K, Dilvoi M, Patatoukas G, Kypraiou E, Nikolaou V, Efstathopoulos E, Kelekis N, Kouloulias V. Clinical application of Total Skin Electron Beam (TSEB) therapy for the management of T cell cutaneous lymphomas. The evolving role of low dose (12 Gy) treatment schedule. Clin Transl Radiat Oncol 2019; 15:26-30. [PMID: 30582018 PMCID: PMC6293019 DOI: 10.1016/j.ctro.2018.12.002] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2018] [Revised: 12/02/2018] [Accepted: 12/04/2018] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND & PURPOSE Although rare, cutaneous lymphomas represent a separate entity in hematologic oncology. T cell origin lymphomas are most common, with Mycosis Fungoides (MF) accounting for about 50-70% of cases. Sezary Syndrome (SS), which represents the leukemic varian of MF, accounts for 3% of Cutaneous T Cell Lymphomas (CTCL). Total Skin Electron Beam Therapy (TSEB) is included at the mainstream of treatment choices for CTCL. The scope of this study is to evaluate the effectiveness and toxicity of two treatment schedules of TSEB. METHODS AND MATERIALS We report our experience with TSEB in the management of MF and SS, as of 14 patients treated in our institution from 2011 to 2015. 8 patients received the 12 Gy (low dose) scheme while 6 patients were managed with 36 Gy (standard or full dose scheme) according to six dual field Stanford technique. The endpoints were overall response rate, duration of response and toxicity of treatment. RESULTS After a median follow up of 2.5 years we noted excellent treatment outcome, with both schemes being well tolerated and resulting in comparable response rates. The overall response rate for both treatment regimens was over 87.5%. Treatment was well tolerated with mild toxicity. CONCLUSION The role of TSEB in the management of MF and SS is well established. The low dose TSEB schedule of 12 Gy is an effective treatment option, since therapeutic results are more than acceptable, compliance is excellent and toxicity is minimal. Moreover, the evidence that it can be repeated safely makes it more attractive than the standard 36 Gy scheme, when a patient is referred to radiation treatment according to treatment guidelines.
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Affiliation(s)
- Ioannis Georgakopoulos
- National Kapodistrian University of Athens, Medical School, 2nd Dpt Radiology, Radiotherapy Unit, ATTIKON University Hospital, Athens, Greece
| | - Evaggelia Papadavid
- National Kapodistrian University of Athens, Medical School, 2nd Dermatology Clinic, ATTIKON University Hospital, Athens, Greece
| | - Kalliopi Platoni
- National Kapodistrian University of Athens, Medical School, 2nd Dpt Radiology, Medical Physics Unit, ATTIKON University Hospital, Athens, Greece
| | - Maria Dilvoi
- National Kapodistrian University of Athens, Medical School, 2nd Dpt Radiology, Medical Physics Unit, ATTIKON University Hospital, Athens, Greece
| | - George Patatoukas
- National Kapodistrian University of Athens, Medical School, 2nd Dpt Radiology, Medical Physics Unit, ATTIKON University Hospital, Athens, Greece
| | - Efrosyni Kypraiou
- National Kapodistrian University of Athens, Medical School, 2nd Dpt Radiology, Radiotherapy Unit, ATTIKON University Hospital, Athens, Greece
| | - Vasiliki Nikolaou
- National Kapodistrian University of Athens, Medical School, 1st Dermatology Clinic, Syggros Hospital, Athens, Greece
| | - Efstathios Efstathopoulos
- National Kapodistrian University of Athens, Medical School, 2nd Dpt Radiology, Medical Physics Unit, ATTIKON University Hospital, Athens, Greece
| | - Nikolaos Kelekis
- National Kapodistrian University of Athens, Medical School, 2nd Dpt Radiology, Radiotherapy Unit, ATTIKON University Hospital, Athens, Greece
| | - Vasilios Kouloulias
- National Kapodistrian University of Athens, Medical School, 2nd Dpt Radiology, Radiotherapy Unit, ATTIKON University Hospital, Athens, Greece
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20
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Gilson D, Whittaker S, Child F, Scarisbrick J, Illidge T, Parry E, Mohd Mustapa M, Exton L, Kanfer E, Rezvani K, Dearden C, Morris S, McHenry P, Leslie T, Wakelin S, Hunasehally R, Cork M, Johnston G, Chiang N, Worsnop F, Salim A, Buckley D, Petrof G, Callachand N, Flavell T, Salad A. British Association of Dermatologists and U.K. Cutaneous Lymphoma Group guidelines for the management of primary cutaneous lymphomas 2018. Br J Dermatol 2018; 180:496-526. [DOI: 10.1111/bjd.17240] [Citation(s) in RCA: 71] [Impact Index Per Article: 11.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/14/2018] [Indexed: 02/07/2023]
Affiliation(s)
- D. Gilson
- Leeds Cancer Centre St James's University Hospital Leeds LS9 7TF U.K
| | - S.J. Whittaker
- St John's Institute of Dermatology Guy's and St Thomas NHS Foundation Trust St Thomas’ Hospital London SE1 7EH U.K
| | - F.J. Child
- St John's Institute of Dermatology Guy's and St Thomas NHS Foundation Trust St Thomas’ Hospital London SE1 7EH U.K
| | - J.J. Scarisbrick
- Queen Elizabeth Hospital University Hospital Birmingham Birmingham B15 2TH U.K
| | - T.M. Illidge
- Institute of Cancer Sciences University of Manchester The Christie NHS Foundation Trust Manchester M20 4BX U.K
| | - E.J. Parry
- Tameside Hospital Integrated Care NHS Foundation Trust Ashton‐under‐Lyne OL6 9RW U.K
| | - M.F. Mohd Mustapa
- British Association of Dermatologists Willan House, 4 Fitzroy Square London W1T 5HQ U.K
| | - L.S. Exton
- British Association of Dermatologists Willan House, 4 Fitzroy Square London W1T 5HQ U.K
| | - E. Kanfer
- Haematology Department Hammersmith Hospital Du Cane Road London W12 0HS U.K
| | - K. Rezvani
- The University of Texas MD Anderson Cancer Centre Houston TX U.S.A
| | - C.E. Dearden
- Chronic Lymphocytic Leukaemia (CLL) Unit The Royal Marsden NHS Foundation Trust Sutton SW3 6JJ U.K
| | - S.L. Morris
- Guy's and St Thomas’ NHS Foundation Trust Guy's Hospital London SE1 9RT U.K
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21
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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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Jang BS, Kim E, Kim IH, Kang HC, Ye SJ. Clinical outcomes and prognostic factors in patients with mycosis fungoides who underwent radiation therapy in a single institution. Radiat Oncol J 2018; 36:153-162. [PMID: 29983036 PMCID: PMC6074064 DOI: 10.3857/roj.2017.00542] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2017] [Accepted: 01/18/2018] [Indexed: 11/03/2022] Open
Abstract
PURPOSE We aimed to evaluate clinical outcomes including progression-free survival (PFS), overall survival (OS), partial response, and complete response in patients who underwent radiation therapy (RT) for mycosis fungoides (MF). Also, we sought to find prognostic factors for clinical outcomes. Materials and. METHODS Total 19 patients confirmed with MF between 1999-2015 were retrospectively reviewed. Clinical and treatment characteristics, clinical outcomes, and and toxicities were analyzed. RESULTS Eleven patients were treated with total skin electron beam radiotherapy (TSEBT) and 8 patients with involved field radiation therapy (IFRT) with median dose of 30 Gy, respectively. The median time interval from diagnosis to RT was 2.6 months (range, 0.4 to 87.3 months). The overall response rate was 100%; 11 patients (57.9%) had a complete response and 8 patients (42.1%) a partial response. The presence of positive lymph node at the time of consultation of RT was associated with lower OS (p = 0.043). In multivariate analysis, PFS was significantly lower for patients with increased previous therapies experienced following RT (p = 0.019) and for patients showing PR during RT (p = 0.044). There were no reported grade 3 or more skin toxicities related with RT. CONCLUSION Both IFRT and TSEBT are effective treatment for MF patients. Patients with short disease course before RT or complete response during RT are expected to have longer PFS. Positive lymph node status at the initiation of RT was associated woth poor OS, suggesting other treatment modalities such as low-dose RT for patients with low life-expectancy.
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Affiliation(s)
- Bum-Sup Jang
- Department of Radiation Oncology, Seoul National University Hospital, Seoul, Korea
| | - Eunji Kim
- Department of Radiation Oncology, Seoul National University Hospital, Seoul, Korea
| | - Il Han Kim
- Department of Radiation Oncology, Seoul National University Hospital, Seoul, Korea.,Institute of Radiation Medicine, Cancer Research Institute, Seoul National University College of Medicine, Seoul, Korea
| | - Hyun-Cheol Kang
- Department of Radiation Oncology, Seoul National University Hospital, Seoul, Korea
| | - Sung-Joon Ye
- Program in Biomedical Radiation Sciences, Department of Transdisciplinary Studies, Graduate School of Convergence Science and Technology, Seoul National University, Seoul, Korea
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23
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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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24
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Janiga J, Kentley J, Nabhan C, Abdulla F. Current systemic therapeutic options for advanced mycosis fungoides and Sézary syndrome. Leuk Lymphoma 2018; 59:562-577. [PMID: 29308723 DOI: 10.1080/10428194.2017.1347650] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Mycosis fungoides (MF) and Sézary syndrome (SS) are the most common cutaneous T-cell lymphomas (CTCLs). Both lack curative options, and advanced-stage carries a poor prognosis. Whilst there are a number of treatments available, achieving and maintaining a durable remission remains challenging. We review current systemic treatment options as monotherapy for advanced-stage MF (IIB-IV), appraising their mechanism of action, analyzing their efficacy, and describing toxicities. Individually, reported overall response rates (ORR) vary widely in the literature and duration of responses are typically short, ranging from 7.5 to 22.4 months. Combined therapy is frequently used in an effort to boost responses, although prospective studies comparing combinations to single agent therapies are rarely conducted. While recent translational research has led to increased understanding of the immunopathogenesis of MF and SS and the development of new treatments, current standard of care therapies are not curative and have low ORR for advanced-stage disease.
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Affiliation(s)
- Jenna Janiga
- a Stritch School of Medicine , Loyola University , Chicago , IL , USA
| | - Jonathan Kentley
- b Department of Dermatology , Royal London Hospital, Barts Health NHS Trust , London , UK
| | - Chadi Nabhan
- c Cardinal Health Specialty Solutions , Waukegan , IL , USA
| | - Farah Abdulla
- d Department of Medicine, Section of Dermatology , University of Chicago Medicine and Biological Sciences , Chicago , IL , USA
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25
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Berg S, Villasenor-Park J, Haun P, Kim EJ. Multidisciplinary Management of Mycosis Fungoides/Sézary Syndrome. Curr Hematol Malig Rep 2017; 12:234-243. [PMID: 28540671 DOI: 10.1007/s11899-017-0387-9] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
PURPOSE OF REVIEW Diagnosis and management of mycosis fungoides and Sézary syndrome (MF/SS) require accurate clinicopathological correlation and a multidisciplinary approach. We reviewed major advances in the field regarding diagnostic and prognostic tools as well as skin-directed therapies (SDTs) and systemic agents for MF/SS published in the past 2 years. RECENT FINDINGS Improved technology (T-cell receptor high-throughput sequencing) and increased multicenter collaboration (Cutaneous Lymphoma International Consortium) have led to diagnostic/prognostic advances. Concurrently, numerous genomic studies have enhanced understanding of disease pathogenesis. Advances in SDTs include topical resiquimod, a novel potent Toll-like receptor (TLR) agonist; consensus CTCL phototherapy guidelines; and use of low-dose radiation therapy. Novel systemic therapies for advanced disease of note include targeted antibody drug conjugates (brentuximab vedotin), immune checkpoint inhibitors, and allogeneic hematopoietic stem cell transplantation (HSCT). Our "toolbox" to diagnose and treat the spectrum of MF/SS continues to expand. Further characterization of genomic data going forward will enable a rational approach to selecting and combining therapies to improve patient care.
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Affiliation(s)
- Sara Berg
- Penn Cutaneous Lymphoma Program, Department of Dermatology, Perelman Center for Advanced Medicine, Perelman School of Medicine at the University of Pennsylvania, 1st Floor South Pavilion, 3400 Civic Center Boulevard, Philadelphia, PA, 19104, USA
| | - Jennifer Villasenor-Park
- Penn Cutaneous Lymphoma Program, Department of Dermatology, Perelman Center for Advanced Medicine, Perelman School of Medicine at the University of Pennsylvania, 1st Floor South Pavilion, 3400 Civic Center Boulevard, Philadelphia, PA, 19104, USA
| | - Paul Haun
- Penn Cutaneous Lymphoma Program, Department of Dermatology, Perelman Center for Advanced Medicine, Perelman School of Medicine at the University of Pennsylvania, 1st Floor South Pavilion, 3400 Civic Center Boulevard, Philadelphia, PA, 19104, USA
| | - Ellen J Kim
- Penn Cutaneous Lymphoma Program, Department of Dermatology, Perelman Center for Advanced Medicine, Perelman School of Medicine at the University of Pennsylvania, 1st Floor South Pavilion, 3400 Civic Center Boulevard, Philadelphia, PA, 19104, USA.
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Santoro D, Kubicek L, Lu B, Craft W, Conway J. Total skin electron therapy as treatment for epitheliotropic lymphoma in a dog. Vet Dermatol 2017; 28:246-e65. [PMID: 28133821 DOI: 10.1111/vde.12415] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/10/2016] [Indexed: 01/19/2023]
Abstract
BACKGROUND Mycosis fungoides (MF) is an uncommon cutaneous neoplasm in dogs. Treatment options are limited. Total skin electron therapy (TSET) has been suggested as a possible therapy for canine MF. OBJECTIVE To describe the use of TSET as palliative treatment for MF in a dog. RESULTS An adult dog, previously diagnosed with nonepidermolytic ichthyosis, was presented with generalized erythroderma, alopecia and erosions. Histopathology revealed a densely cellular, well-demarcated, unencapsulated infiltrate extending from the epidermis to the mid-dermis compatible with MF. The infiltrate exhibited epitheliotropism multifocally for the epidermis, infundibula and adnexa. Due to a lack of response to chemotherapy, TSET was elected. Six megavoltage electrons were delivered using a 21EX Varian linear accelerator. A dose of 6 Gy was delivered to the skin surface and a 100 cm skin to surface distance was used for dog setup. The treatment time for the cranial half treatment was 3 h. The treatment was divided in two sessions (cranial and caudal halves of the body) 15 days apart. Clinical and histopathological complete remission was achieved and the dog was kept in remission with no additional treatments for 19 months before relapse and development of Sézary syndrome. CONCLUSION AND CLINICAL SIGNIFICANCE To the best of the authors' knowledge, this is the first case reporting the use of TSET for medically refractory canine MF with post treatment follow-up. This case suggests that the use of TSET may be an effective palliative treatment for canine MF.
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Affiliation(s)
- Domenico Santoro
- Department of Small Animal Clinical Sciences, College of Veterinary Medicine, University of Florida, 2015 SW 16th Avenue, Gainesville, FL, 32610, USA
| | - Lyndsay Kubicek
- Department of Small Animal Clinical Sciences, College of Veterinary Medicine, University of Florida, 2015 SW 16th Avenue, Gainesville, FL, 32610, USA
| | - Bo Lu
- J. Crayton Pruitt Family Department of Biomedical Engineering, University of Florida, 1275 Center Drive, Gainesville, FL, 32611, USA
| | - William Craft
- Department of Pathobiology, College of Veterinary Medicine, University of Florida, 2015 SW 16th Avenue, Gainesville, FL, 32610, USA
| | - Julia Conway
- Department of Pathobiology, College of Veterinary Medicine, University of Florida, 2015 SW 16th Avenue, Gainesville, FL, 32610, USA
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Kim SW, Kwak J, Cho B, Song SY, Lee SW, Jeong C. Clinical Implementation of 3D Printing in the Construction of Patient Specific Bolus for Photon Beam Radiotherapy for Mycosis Fungoides. ACTA ACUST UNITED AC 2017. [DOI: 10.14316/pmp.2017.28.1.33] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Affiliation(s)
- Sung-woo Kim
- Department of Radiation Oncology, Asan Medical Center, Seoul, Korea
| | - Jungwon Kwak
- Department of Radiation Oncology, Asan Medical Center, Seoul, Korea
| | - Byungchul Cho
- Department of Radiation Oncology, University of Ulsan College of Medicine, Seoul, Korea
| | - Si Yeol Song
- Department of Radiation Oncology, University of Ulsan College of Medicine, Seoul, Korea
| | - Sang-wook Lee
- Department of Radiation Oncology, University of Ulsan College of Medicine, Seoul, Korea
| | - Chiyoung Jeong
- Department of Radiation Oncology, Asan Medical Center, Seoul, Korea
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Chowdhary M, Chhabra AM, Kharod S, Marwaha G. Total Skin Electron Beam Therapy in the Treatment of Mycosis Fungoides: A Review of Conventional and Low-Dose Regimens. CLINICAL LYMPHOMA MYELOMA & LEUKEMIA 2016; 16:662-671. [PMID: 27692530 DOI: 10.1016/j.clml.2016.08.019] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/06/2016] [Revised: 08/16/2016] [Accepted: 08/18/2016] [Indexed: 10/21/2022]
Abstract
Mycosis fungoides (MF) is the most prevalent subtype of cutaneous T-cell lymphoma, which is characterized by the proliferation of CD4+ T cells. While often an indolent disease, most patients eventually develop progression from isolated patches to tumors and finally nodal or visceral involvement. Treatment choice is largely based on disease burden, though prognostic factors such as disease stage, patient age, and extracutaneous involvement must be taken into consideration. Radiotherapy represents one of the most effective therapeutic modalities in the treatment of MF. Lymphocytes are exquisitely radiosensitive, and excellent responses are observed even with low doses of radiation. Total skin electron beam therapy (TSEBT) is a special technique that allows for the homogenous irradiation of the entire skin. There are well-documented radiation dose-response relationships for achieving a complete response. As such, TSEBT doses ≥ 30 Gy comprise the current standard of care. Although highly effective, most patients experience recurrent disease even after conventional-dose (≥ 30 Gy) TSEBT. In addition, toxicity is cumulatively dose dependent, and there is reluctance to administer multiple courses of conventional-dose TSEBT. Consequently, there has been renewed interest in determining the utility of TSEBT at lower total (≤ 30 Gy) doses. Advantages of low-total-dose (with standard dose per fraction) TSEBT include a shortened treatment course, the potential to minimize the risk of adverse events, and the opportunity to allow for retreatment in cases of disease recurrence. This comprehensive review compares the impact of different TSEBT dosing schemes on clinical outcomes of MF.
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Affiliation(s)
- Mudit Chowdhary
- Department of Radiation Oncology, Rush University Medical Center, Chicago, IL.
| | - Arpit M Chhabra
- Department of Radiation Oncology, University of Maryland School of Medicine, Baltimore, MD
| | - Shivam Kharod
- Department of Radiation Oncology, University of Florida College of Medicine, Gainesville, FL
| | - Gaurav Marwaha
- Department of Radiation Oncology, Rush University Medical Center, Chicago, IL
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How I treat mycosis fungoides and Sézary syndrome. Blood 2016; 127:3142-53. [DOI: 10.1182/blood-2015-12-611830] [Citation(s) in RCA: 82] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2015] [Accepted: 04/12/2016] [Indexed: 12/11/2022] Open
Abstract
AbstractMycosis fungoides (MF) is the most common primary cutaneous T-cell lymphoma variant and is closely related to a rare leukemic variant, Sézary syndrome (SS). MF patients at risk of disease progression can now be identified and an international consortium has been established to address the prognostic relevance of specific biologic factors and define a prognostic index. There are a lack of randomized clinical trial data in MF/SS and evidence is based on a traditional “stage-based” approach; treatment of early-stage disease (IA-IIA) involves skin directed therapies which include topical corticosteroids, phototherapy (psoralen with UVA or UVB), topical chemotherapy, topical bexarotene, and radiotherapy including total skin electron beam therapy. Systemic approaches are used for refractory early-stage and advanced-stage disease (IIB-IV) and include bexarotene, interferon α, extracorporeal photopheresis, histone deacetylase inhibitors, and antibody therapies such as alemtuzumab, systemic chemotherapy, and allogeneic transplantation. However, despite the number of biologic agents available, the treatment of advanced-stage disease still represents an unmet medical need with short duration of responses. Encouragingly, randomized phase 3 trials are assessing novel agents, including brentuximab vedotin and the anti-CCR4 antibody, mogamulizumab. A broader understanding of the biology of MF/SS will hopefully identify more effective targeted therapies.
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Evans JD, Haley LL, Locher SE, Grams MP, Deufel CL, Antolak JA, Martenson JA. Clinical application of lying-on-the-floor total skin electron irradiation for frail patients with cutaneous lymphoma: An emphasis on the importance of in vivo dosimetry. Adv Radiat Oncol 2016; 1:101-105. [PMID: 28740876 PMCID: PMC5506731 DOI: 10.1016/j.adro.2016.03.005] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2016] [Revised: 03/24/2016] [Accepted: 03/26/2016] [Indexed: 11/30/2022] Open
Affiliation(s)
- Jaden D Evans
- Department of Radiation Oncology, Mayo Clinic, Rochester, Minnesota
| | - Laura L Haley
- Michigan State University College of Human Medicine, Grand Rapids, Michigan
| | - Sarah E Locher
- Department of Radiation Oncology, Mayo Clinic, Rochester, Minnesota
| | - Michael P Grams
- Department of Radiation Oncology, Mayo Clinic, Rochester, Minnesota
| | | | - John A Antolak
- Department of Radiation Oncology, Mayo Clinic, Rochester, Minnesota
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Adaptation of the Stanford technique for treatment of bulky cutaneous T-cell lymphoma of the head. Pract Radiat Oncol 2015; 6:183-186. [PMID: 26712465 DOI: 10.1016/j.prro.2015.10.021] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2015] [Revised: 10/27/2015] [Accepted: 10/28/2015] [Indexed: 11/20/2022]
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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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Abstract
Radiation therapy is an extraordinarily effective skin-directed therapy for cutaneous T-cell lymphomas. Lymphocytes are extremely sensitive to radiation and a complete response is generally achieved even with low doses. Radiation therapy has several important roles in the management of mycosis fungoides. For the rare patient with unilesional disease, radiation therapy alone is potentially curative. For patients with more advanced cutaneous disease, radiation therapy to local lesions or to the entire skin can effectively palliate symptomatic disease and provide local disease control. Compared with other skin-directed therapies, radiation therapy is particularly advantageous because it can effectively penetrate and treat thicker plaques and tumors.
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Affiliation(s)
- Daniel J Tandberg
- Department of Radiation Oncology, Duke University Medical Center, DUMC BOX 3085, Durham, NC 27710, USA
| | - Oana Craciunescu
- Department of Radiation Oncology, Duke University Medical Center, DUMC BOX 3085, Durham, NC 27710, USA
| | - Chris R Kelsey
- Department of Radiation Oncology, Duke University Medical Center, DUMC BOX 3085, Durham, NC 27710, USA.
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Specht L, Dabaja B, Illidge T, Wilson LD, Hoppe RT. Modern radiation therapy for primary cutaneous lymphomas: field and dose guidelines from the International Lymphoma Radiation Oncology Group. Int J Radiat Oncol Biol Phys 2015; 92:32-9. [PMID: 25863751 DOI: 10.1016/j.ijrobp.2015.01.008] [Citation(s) in RCA: 114] [Impact Index Per Article: 12.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2014] [Revised: 01/06/2015] [Accepted: 01/09/2015] [Indexed: 10/23/2022]
Abstract
Primary cutaneous lymphomas are a heterogeneous group of diseases. They often remain localized, and they generally have a more indolent course and a better prognosis than lymphomas in other locations. They are highly radiosensitive, and radiation therapy is an important part of the treatment, either as the sole treatment or as part of a multimodality approach. Radiation therapy of primary cutaneous lymphomas requires the use of special techniques that form the focus of these guidelines. The International Lymphoma Radiation Oncology Group has developed these guidelines after multinational meetings and analysis of available evidence. The guidelines represent an agreed consensus view of the International Lymphoma Radiation Oncology Group steering committee on the use of radiation therapy in primary cutaneous lymphomas in the modern era.
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Affiliation(s)
- Lena Specht
- Departments of Oncology and Hematology, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark.
| | - Bouthaina Dabaja
- Division of Radiation Oncology, Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Tim Illidge
- Institute of Cancer Sciences, University of Manchester, Manchester Academic Health Sciences Centre, The Christie National Health Service Foundation Trust, Manchester, United Kingdom
| | - Lynn D Wilson
- Department of Therapeutic Radiology, Yale University School of Medicine, New Haven, Connecticut
| | - Richard T Hoppe
- Department of Radiation Oncology, Stanford University, Stanford, California
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Hughes CFM, Newland K, McCormack C, Lade S, Prince HM. Mycosis fungoides and Sézary syndrome: Current challenges in assessment, management and prognostic markers. Australas J Dermatol 2015; 57:182-91. [DOI: 10.1111/ajd.12349] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2014] [Accepted: 04/05/2015] [Indexed: 12/24/2022]
Affiliation(s)
- Charlotte FM Hughes
- Division of Haematology and Cancer Medicine; Peter MacCallum Cancer Centre; Melbourne Victoria Australia
- Sir Peter MacCallum Department of Oncology; University of Melbourne; Melbourne Victoria Australia
| | - Kate Newland
- Department of Dermatology; St Vincent's Hospital Department of Medicine; Melbourne Victoria Australia
| | - Christopher McCormack
- Sir Peter MacCallum Department of Oncology; University of Melbourne; Melbourne Victoria Australia
- Department of Dermatology; St Vincent's Hospital Department of Medicine; Melbourne Victoria Australia
| | - Stephen Lade
- Division of Pathology; Peter MacCallum Cancer Centre; Melbourne Victoria Australia
| | - H Miles Prince
- Division of Haematology and Cancer Medicine; Peter MacCallum Cancer Centre; Melbourne Victoria Australia
- Sir Peter MacCallum Department of Oncology; University of Melbourne; Melbourne Victoria Australia
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Majithia L, Rong Y, Siddiqui F, Hattie T, Gupta N, Weldon M, Chakravarti A, Wong HK, Porcu P, Xu-Welliver M. Treating cutaneous T-cell lymphoma with highly irregular surfaces with photon irradiation using rice as tissue compensator. Front Oncol 2015; 5:49. [PMID: 25759793 PMCID: PMC4338671 DOI: 10.3389/fonc.2015.00049] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2014] [Accepted: 02/11/2015] [Indexed: 11/13/2022] Open
Abstract
PURPOSE Cutaneous T-cell lymphoma (CTCL) is known to have an excellent response to radiotherapy, an important treatment modality for this disease. In patients with extremity and digit involvement, the irregular surface and depth variations create difficulty in delivering a homogenous dose using electrons. We sought to evaluate photon irradiation with rice packing as tissue equivalence and determine clinical tolerance and response. MATERIALS AND METHODS Three consecutive CTCL patients with extensive lower extremity involvement including the digits were treated using external beam photon therapy with rice packing for tissue compensation. The entire foot was treated to 30-40 Gy in 2-3 Gy per fraction using 6 MV photons prescribed to the mid-plane of an indexed box filled with rice in which the foot was placed. Treatment tolerance and response were monitored with clinical evaluation. RESULTS All patients tolerated the treatment without treatment breaks. Toxicities included grade 3 erythema and desquamation with resolution within 4 weeks. No late toxicities were observed. All patients had a partial response by 4 weeks after therapy with two patients achieving a complete response. Patients reported improved functionality after treatment. No local recurrence has been observed. CONCLUSION Tissue compensation with rice packing offers a convenient, inexpensive, and reproducible method for the treatment of CTCL with highly irregular surfaces.
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Affiliation(s)
- Lonika Majithia
- Department of Radiation Oncology, James Cancer Hospital, The Ohio State University , Columbus, OH , USA
| | - Yi Rong
- Department of Radiation Oncology, University of California Davis Comprehensive Cancer Center , Sacramento, CA , USA
| | - Farzan Siddiqui
- Department of Radiation Oncology, Henry Ford Health System , Detroit, MI , USA
| | - Todd Hattie
- Department of Radiation Oncology, James Cancer Hospital, The Ohio State University , Columbus, OH , USA
| | - Nilendu Gupta
- Department of Radiation Oncology, James Cancer Hospital, The Ohio State University , Columbus, OH , USA
| | - Michael Weldon
- Department of Radiation Oncology, James Cancer Hospital, The Ohio State University , Columbus, OH , USA
| | - Arnab Chakravarti
- Department of Radiation Oncology, James Cancer Hospital, The Ohio State University , Columbus, OH , USA
| | - Henry K Wong
- Division of Dermatology, Department of Internal Medicine, James Cancer Hospital, The Ohio State University , Columbus, OH , USA
| | - Pierluigi Porcu
- Division of Hematology, Department of Internal Medicine, James Cancer Hospital, The Ohio State University , Columbus, OH , USA
| | - Meng Xu-Welliver
- Department of Radiation Oncology, James Cancer Hospital, The Ohio State University , Columbus, OH , USA
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Heumann TR, Esiashvili N, Parker S, Switchenko JM, Dhabbaan A, Goodman M, Lechowicz MJ, Flowers CR, Khan MK. Total skin electron therapy for cutaneous T-cell lymphoma using a modern dual-field rotational technique. Int J Radiat Oncol Biol Phys 2015; 92:183-91. [PMID: 25670538 DOI: 10.1016/j.ijrobp.2014.11.033] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2014] [Revised: 11/19/2014] [Accepted: 11/24/2014] [Indexed: 11/30/2022]
Abstract
PURPOSE To report our experience with rotational total skin electron irradiation (RTSEI) in cutaneous T-cell lymphoma (CTCL), and to examine response by disease stage and race. METHODS AND MATERIALS We reviewed our outcomes for 68 CTCL patients who received RTSEI (≥ 30 Gy) from 2000 to 2013. Primary outcomes were complete clinical response (CCR), recurrence-free survival (RFS), and overall survival (OS). Using log-rank tests and Cox proportional hazards, OS and RFS were compared across tumor stages at time of RTSEI with further racial subgroup analysis. RESULTS Median age at diagnosis and at time of radiation was 52 and 56 years, respectively. Median follow-up was 5.1 years, 49% were African American, and 49% were female. At time of treatment, 18, 37, and 13 patients were T stage 2, 3, and 4, respectively. At 6 weeks after RTSEI, overall CCR was 82% (88%, 83%, and 69% for T2, T3, and T4, respectively). Median RFS was 11 months for all patients and 14, 10, and 12 months for stage T2, T3, and T4, respectively. Tumor stage was not associated with RFS or CCR. Maintenance therapy after RTSEI was associated with improved RFS in both crude and multivariable analysis, controlling for T stage. Median OS was 76 months (91 and 59 months for T3 and T4, respectively). With the exception of improved OS in African Americans compared with whites at stage T2, race was not associated with CCR, RFS, or OS. CONCLUSIONS These results represent the largest RTSEI clinical outcomes study in the modern era using a dual-field rotational technique. Our observed response rates match or improve upon the standard set by previous outcome studies using conventional TSEI techniques, despite a large percentage of advanced CTCL lesions in our cohort. We found that clinical response after RTSEI did not seem to be affected by T stage or race.
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Affiliation(s)
| | - Natia Esiashvili
- Department of Radiation Oncology, Emory University, Atlanta, Georgia; Winship Cancer Institute (WCI), Emory University, Atlanta, Georgia
| | - Sareeta Parker
- Department of Dermatology, Emory University, Atlanta, Georgia
| | | | - Anees Dhabbaan
- Department of Radiation Oncology, Emory University, Atlanta, Georgia; Winship Cancer Institute (WCI), Emory University, Atlanta, Georgia
| | - Michael Goodman
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, Georgia
| | - Mary Jo Lechowicz
- Department of Radiation Oncology, Emory University, Atlanta, Georgia; Department of Hematology and Oncology, Emory University, Atlanta, Georgia
| | - Christopher R Flowers
- Department of Radiation Oncology, Emory University, Atlanta, Georgia; Department of Hematology and Oncology, Emory University, Atlanta, Georgia
| | - Mohammad K Khan
- Department of Radiation Oncology, Emory University, Atlanta, Georgia; Winship Cancer Institute (WCI), Emory University, Atlanta, Georgia.
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Hoppe RT, Harrison C, Tavallaee M, Bashey S, Sundram U, Li S, Million L, Dabaja B, Gangar P, Duvic M, Kim YH. Low-dose total skin electron beam therapy as an effective modality to reduce disease burden in patients with mycosis fungoides: Results of a pooled analysis from 3 phase-II clinical trials. J Am Acad Dermatol 2015; 72:286-92. [DOI: 10.1016/j.jaad.2014.10.014] [Citation(s) in RCA: 98] [Impact Index Per Article: 10.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2014] [Revised: 09/27/2014] [Accepted: 10/13/2014] [Indexed: 10/24/2022]
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Fahimian B, Ceballos A, Türkcan S, Kapp DS, Pratx G. Seeing the invisible: direct visualization of therapeutic radiation beams using air scintillation. Med Phys 2014; 41:010702. [PMID: 24387491 DOI: 10.1118/1.4851595] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
PURPOSE To assess whether air scintillation produced during standard radiation treatments can be visualized and used to monitor a beam in a nonperturbing manner. METHODS Air scintillation is caused by the excitation of nitrogen gas by ionizing radiation. This weak emission occurs predominantly in the 300-430 nm range. An electron-multiplication charge-coupled device camera, outfitted with an f/0.95 lens, was used to capture air scintillation produced by kilovoltage photon beams and megavoltage electron beams used in radiation therapy. The treatment rooms were prepared to block background light and a short-pass filter was utilized to block light above 440 nm. RESULTS Air scintillation from an orthovoltage unit (50 kVp, 30 mA) was visualized with a relatively short exposure time (10 s) and showed an inverse falloff (r(2) = 0.89). Electron beams were also imaged. For a fixed exposure time (100 s), air scintillation was proportional to dose rate (r(2) = 0.9998). As energy increased, the divergence of the electron beam decreased and the penumbra improved. By irradiating a transparent phantom, the authors also showed that Cherenkov luminescence did not interfere with the detection of air scintillation. In a final illustration of the capabilities of this new technique, the authors visualized air scintillation produced during a total skin irradiation treatment. CONCLUSIONS Air scintillation can be measured to monitor a radiation beam in an inexpensive and nonperturbing manner. This physical phenomenon could be useful for dosimetry of therapeutic radiation beams or for online detection of gross errors during fractionated treatments.
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Affiliation(s)
- Benjamin Fahimian
- Department of Radiation Oncology, Stanford University School of Medicine, Stanford, California 94305
| | - Andrew Ceballos
- Department of Electrical Engineering, Stanford University, Stanford, California 94305
| | - Silvan Türkcan
- Department of Radiation Oncology, Stanford University School of Medicine, Stanford, California 94305
| | - Daniel S Kapp
- Department of Radiation Oncology, Stanford University School of Medicine, Stanford, California 94305
| | - Guillem Pratx
- Department of Radiation Oncology, Stanford University School of Medicine, Stanford, California 94305
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Hernández Z, Peñate Y, Hernández-Machín B, Pérez-Méndez L, Suárez-Hernández J, Hernández J, Fernández-de-Misa R. Treatment of stage Ia and Ib mycosis fungoides with psoralen UVA monotherapy: an observational study in tertiary hospitals in the Canary Islands. Int J Dermatol 2014; 53:1417-22. [DOI: 10.1111/ijd.12425] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- Zaida Hernández
- Department of Dermatology; Complejo Hospitalario Universitario Insular Materno-Infantil; Maternity and Children's Hospital; University Hospital Complex; Las Palmas de Gran Canaria Spain
| | - Yeray Peñate
- Department of Dermatology; Complejo Hospitalario Universitario Insular Materno-Infantil; Maternity and Children's Hospital; University Hospital Complex; Las Palmas de Gran Canaria Spain
| | | | - Lina Pérez-Méndez
- Dermatology Research Unit; University of La Laguna; San Cristóbal de la Laguna; Tenerife Spain
- Department of Dermatology; University Hospital Nuestra Señora de Candelaria; Santa Cruz de Tenerife Spain
| | - Jose Suárez-Hernández
- Department of Dermatology; University Hospital Nuestra Señora de Candelaria; Santa Cruz de Tenerife Spain
| | - Javier Hernández
- Department of Dermatology; Complejo Hospitalario Universitario Insular Materno-Infantil; Maternity and Children's Hospital; University Hospital Complex; Las Palmas de Gran Canaria Spain
| | - Ricardo Fernández-de-Misa
- Dermatology Research Unit; University of La Laguna; San Cristóbal de la Laguna; Tenerife Spain
- Department of Dermatology; University Hospital Nuestra Señora de Candelaria; Santa Cruz de Tenerife Spain
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Jawed SI, Myskowski PL, Horwitz S, Moskowitz A, Querfeld C. Primary cutaneous T-cell lymphoma (mycosis fungoides and Sézary syndrome): part II. Prognosis, management, and future directions. J Am Acad Dermatol 2014; 70:223.e1-17; quiz 240-2. [PMID: 24438970 DOI: 10.1016/j.jaad.2013.08.033] [Citation(s) in RCA: 205] [Impact Index Per Article: 20.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2013] [Revised: 08/13/2013] [Accepted: 08/16/2013] [Indexed: 12/20/2022]
Abstract
Both mycosis fungoides (MF) and Sézary syndrome (SS) have a chronic, relapsing course, with patients frequently undergoing multiple, consecutive therapies. Treatment is aimed at the clearance of skin disease, the minimization of recurrence, the prevention of disease progression, and the preservation of quality of life. Other important considerations are symptom severity, including pruritus and patient age/comorbidities. In general, for limited patch and plaque disease, patients have excellent prognosis on ≥1 topical formulations, including topical corticosteroids and nitrogen mustard, with widespread patch/plaque disease often requiring phototherapy. In refractory early stage MF, transformed MF, and folliculotropic MF, a combination of skin-directed therapy plus low-dose immunomodulators (eg, interferon or bexarotene) may be effective. Patients with advanced and erythrodermic MF/SS can have profound immunosuppression, with treatments targeting tumor cells aimed for immune reconstitution. Biologic agents or targeted therapies either alone or in combination--including immunomodulators and histone-deacetylase inhibitors--are tried first, with more immunosuppressive therapies, such as alemtuzumab or chemotherapy, being generally reserved for refractory or rapidly progressive disease or extensive lymph node and metastatic involvement. Recently, an increased understanding of the pathogenesis of MF and SS with identification of important molecular markers has led to the development of new targeted therapies that are currently being explored in clinical trials in advanced MF and SS.
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Affiliation(s)
- Sarah I Jawed
- Dermatology Service, Department of Medicine, Memorial Sloan-Kettering Cancer Center and Weill Cornell Medical College, New York, New York
| | - Patricia L Myskowski
- Dermatology Service, Department of Medicine, Memorial Sloan-Kettering Cancer Center and Weill Cornell Medical College, New York, New York
| | - Steven Horwitz
- Lymphoma Service, Department of Medicine, Memorial Sloan-Kettering Cancer Center and Weill Cornell Medical College, New York, New York
| | - Alison Moskowitz
- Lymphoma Service, Department of Medicine, Memorial Sloan-Kettering Cancer Center and Weill Cornell Medical College, New York, New York
| | - Christiane Querfeld
- Dermatology Service, Department of Medicine, Memorial Sloan-Kettering Cancer Center and Weill Cornell Medical College, New York, New York.
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Helical tomotherapy in oncodermatology: Case report of circumferential cutaneous lymphoma treated by this optimized radiotherapy. Cancer Radiother 2014; 18:136-8. [PMID: 24418001 DOI: 10.1016/j.canrad.2013.10.011] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2013] [Revised: 10/09/2013] [Accepted: 10/22/2013] [Indexed: 11/21/2022]
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Mazzeo E, Rubino L, Buglione M, Antognoni P, Magrini SM, Bertoni F, Parmiggiani M, Barbieri P, Bertoni F. The current management of mycosis fungoides and Sézary syndrome and the role of radiotherapy: Principles and indications. Rep Pract Oncol Radiother 2014; 19:77-91. [PMID: 24936325 PMCID: PMC4054991 DOI: 10.1016/j.rpor.2013.07.009] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2013] [Revised: 06/17/2013] [Accepted: 07/16/2013] [Indexed: 10/26/2022] Open
Abstract
AIM To evaluate the current treatment of mycosis fungoides (MF) and Sézary syndrome (SS) focusing on the role of radiotherapy (RT), its principles and indications, and the perspectives of the novel irradiation technologies. BACKGROUND MF and SS are rare lymphoproliferative diseases whose incidence is increasing. For a long time RT has been used as a single modality or in integrated treatment programs for these diseases. MATERIALS AND METHODS The latest systematic reviews, primary studies and new diagnostic and treatment guidelines on MF and SS were analyzed. Clinical outcomes together with the technical aspects and the role of RT were also evaluated. RESULTS New data are available on pathogenesis, diagnostic criteria, classification and staging procedures for MF and SS and several local and systemic therapies are proposed. Localized RT can cure "minimal stage" MF while total skin electron beam irradiation (TSEI) may cure initial-stage disease and may offer important symptom relief (itch, erythroderma) in a more advanced setting. Despite its efficacy, RT is not largely used, mainly because of some technical difficulties but new RT technologies may be proposed to treat large skin surfaces. CONCLUSIONS New treatment programs offer good results, with median survival of more than 12 years in early-stage MF, but the median survival of 2.5 years or less in advanced stages is still a challenge. RT remains an option for all stages with a good cost/effectiveness ratio in a curative or palliative setting. New RT technologies can overcome some technical problems of treating large skin surfaces.
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Affiliation(s)
- Ercole Mazzeo
- Department of Radiation Oncology, Azienda Ospedaliero-Universitaria Policlinico, Modena, Italy
| | - Laura Rubino
- Department of Radiation Oncology, Azienda Ospedaliero-Universitaria Policlinico, Modena, Italy
| | - Michela Buglione
- Department of Radiation Oncology, Brescia University, Istituto del Radio “O. Alberti”, Brescia, Italy
| | - Paolo Antognoni
- Department of Radiotherapy, Azienda Ospedaliera Universitaria Ospedale di Circolo e Fondazione Macchi, Varese, Italy
| | - Stefano Maria Magrini
- Department of Radiation Oncology, Brescia University, Istituto del Radio “O. Alberti”, Brescia, Italy
| | - Francesco Bertoni
- Department of Radiation Oncology, Brescia University, Istituto del Radio “O. Alberti”, Brescia, Italy
| | - Manuela Parmiggiani
- Department of Radiation Oncology, Azienda Ospedaliero-Universitaria Policlinico, Modena, Italy
| | - Paola Barbieri
- Department of Radiation Oncology, Azienda Ospedaliero-Universitaria Policlinico, Modena, Italy
| | - Filippo Bertoni
- Department of Radiation Oncology, Azienda Ospedaliero-Universitaria Policlinico, Modena, Italy
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Moraes FYD, Carvalho HDA, Hanna SA, Silva JLFD, Marta GN. Literature review of clinical results of total skin electron irradiation (TSEBT) of mycosis fungoides in adults. Rep Pract Oncol Radiother 2013; 19:92-8. [PMID: 24936326 DOI: 10.1016/j.rpor.2013.08.003] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2013] [Revised: 07/11/2013] [Accepted: 08/22/2013] [Indexed: 02/08/2023] Open
Abstract
BACKGROUND Mycosis fungoides (MF) is an extranodal, indolent non-Hodgkin lymphoma of T cell origin. Even with the establishment of MF staging, the initial treatment strategy often remains unclear. AIM The aim of this study was to review the clinical results of total skin electron beam therapy (TSEBT) for MF in adults published in English language scientific journals searched in Pubmed/Medline database until December 2012. RESULTS MF is very sensitive to radiation therapy (RT) delivered either by photons or by electrons. In limited patches and/or plaques local electron beam irradiation results in good outcomes besides the fact of not being superior to other modalities. For extensive patches and/or plaques data suggest that TSEBT shows superior response rates. The cutaneous disease presentation is favorably managed with radiotherapy due to its ability to treat the full thickness of deeply infiltrated skin. For generalized erythroderma presentation, TSEBT seems to be an appropriate initial therapy. For advanced disease, palliation, or recurrence after the first radiotherapy treatment course, TSEBT may still be beneficial, with acceptable toxicity. Recommended dose is 30-36 Gy delivered in 6-10 weeks. CONCLUSION TSEBT can be used to treat any stage of MF. It also presents good tumor response with symptoms of relief and a palliative effect on MF, either after previous irradiation or failure of other treatment strategies.
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Affiliation(s)
| | - Heloisa de Andrade Carvalho
- Department of Radiation Oncology, Hospital Sírio-Libânes, São Paulo, SP, Brazil ; Radiotherapy - Department of Radiology and Oncology, Radiology Institute - InRad, Hospital das Clínicas, Universidade de São Paulo, São Paulo, SP, Brazil
| | | | | | - Gustavo Nader Marta
- Department of Radiation Oncology, Hospital Sírio-Libânes, São Paulo, SP, Brazil ; Department of Radiation Oncology, Instituto do Câncer do Estado de São Paulo - ICESP, São Paulo, SP, Brazil
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Kaźmierska J. Clinical results of the total skin electron irradiation of the mycosis fungoides in adults. Conventional fractionation and low dose schemes. Rep Pract Oncol Radiother 2013; 19:99-103. [PMID: 24936327 DOI: 10.1016/j.rpor.2013.08.008] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2013] [Revised: 06/26/2013] [Accepted: 08/22/2013] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Mycosis fungoides (MF) is a rare skin condition, effectively treated by irradiation. Since 1951, different methods of total skin irradiation have been developed. Although dose-response effect has been demonstrated in many publications, controversies about low dose treatment still exist. AIM The analysis of results of the total skin electron irradiation (TSEI), especially low dose TSEI in comparison with standard dose treatment is the subject of this review. Also, acute and late side effects of radiotherapy in MF are discussed. MATERIALS AND METHODS Medline search and analysis of studies published between 1995 and 2012, containing key words: mycosis fungoides, standard dose TSEI, low dose TSEI, total skin electron beam therapy (TSEBT). RESULTS Detailed analysis of relevant studies demonstrated that standard dose radiotherapy 30-36 Gy is the most effective treatment used in clinical practice. Objective response rate (ORR) is high, especially for less advanced stages of disease. Complete response rate (CR), although slightly lower, is still relatively high. For more advanced MF, TSEI serves as a very good method of palliative treatment and relief of symptoms, like pruritus, pain or desquamation. There is no consensus regarding low dose TSEI; the method is widely accepted as a palliative treatment or in case of reirradiation. CONCLUSIONS Standard dose TSEI is an effective method of MF treatment for radical and palliative treatment, producing high rate of ORR and reasonably long time to progression (TTP). Acute and late side effect of treatment are mostly mild and easy to manage. Low dose TSEI is still in the phase of clinical studies.
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Affiliation(s)
- Joanna Kaźmierska
- Radiotherapy Department II, Greater Poland Cancer Center, Poznan, Poland ; Electroradiology Department, University of Medical Sciences, Poznan, Poland
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Luĉić F, Sánchez-Nieto B, Caprile P, Zelada G, Goset K. Dosimetric characterization and optimization of a customized Stanford total skin electron irradiation (TSEI) technique. J Appl Clin Med Phys 2013; 14:231-42. [PMID: 24036877 PMCID: PMC5714578 DOI: 10.1120/jacmp.v14i5.4388] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2013] [Revised: 04/01/2013] [Accepted: 03/21/2013] [Indexed: 11/23/2022] Open
Abstract
Total skin electron irradiation (TSEI) has been used as a treatment for mycosis fungoides. Our center has implemented a modified Stanford technique with six pairs of 6 MeV adjacent electron beams, incident perpendicularly on the patient who remains lying on a translational platform, at 200 cm from the source. The purpose of this study is to perform a dosimetric characterization of this technique and to investigate its optimization in terms of energy characteristics, extension, and uniformity of the treatment field. In order to improve the homogeneity of the distribution, a custom‐made polyester filter of variable thickness and a uniform PMMA degrader plate were used. It was found that the characteristics of a 9 MeV beam with an 8 mm thick degrader were similar to those of the 6 MeV beam without filter, but with an increased surface dose. The combination of the degrader and the polyester filter improved the uniformity of the distribution along the dual field (180 cm long), increasing the dose at the borders of field by 43%. The optimum angles for the pair of beams were ± 27°. This configuration avoided displacement of the patient, and reduced the treatment time and the positioning problems related to the abutting superior and inferior fields. Dose distributions in the transversal plane were measured for the six incidences of the Stanford technique with film dosimetry in an anthropomorphic pelvic phantom. This was performed for the optimized treatment and compared with the previously implemented technique. The comparison showed an increased superficial dose and improved uniformity of the 85% isodose curve coverage for the optimized technique. PACS numbers: 87.53.Bn, 87.55.ne, 87.56.bd
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Wang CM, Duvic M, Dabaja BS. Acral erosive mycosis fungoides: successful treatment with localised radiotherapy. BMJ Case Rep 2013; 2013:bcr-2012-007120. [PMID: 23595169 DOI: 10.1136/bcr-2012-007120] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Mycosis fungoides encompasses a wide range of variants with differing clinical and histopathological findings, clinical courses and methods of treatment. Two patients were referred to MD Anderson Cancer Center for the evaluation of treatment-refractory palmoplantar dermatoses suggestive of a rare variant of mycosis fungoides-mycosis fungoides palmaris et plantaris (MFPP). Both patients eventually had progressive and ulcerative cutaneous disease extending beyond acral regions that showed remarkable response to local radiation therapy. Although most documented cases of MFPP show an indolent course, one must be aware of the possibility of development of severe cutaneous disease in patients initially presenting with palmoplantar involvement. Local radiotherapy is a safe and effective palliative treatment option for MFPP and cutaneous disease refractory to systemic treatment.
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Specht L. Radiotherapy Studies and Extra-nodal Non-Hodgkin Lymphomas, Progress and Challenges. Clin Oncol (R Coll Radiol) 2012; 24:313-8. [DOI: 10.1016/j.clon.2012.02.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2012] [Revised: 02/06/2012] [Accepted: 02/24/2012] [Indexed: 12/14/2022]
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50
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Morris S. Skin Lymphoma. Clin Oncol (R Coll Radiol) 2012; 24:371-85. [DOI: 10.1016/j.clon.2012.02.007] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2011] [Accepted: 02/22/2012] [Indexed: 11/26/2022]
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