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Falke I, Elsayad K, Channaoui M, Kandler C, Moustakis C, Theodor Eich H. Physical and clinical results of a radiation bra in patients treated with total skin electron beam therapy. Phys Imaging Radiat Oncol 2024; 31:100628. [PMID: 39253732 PMCID: PMC11381991 DOI: 10.1016/j.phro.2024.100628] [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: 04/08/2024] [Revised: 08/12/2024] [Accepted: 08/13/2024] [Indexed: 09/11/2024] Open
Abstract
Total skin electron beam therapy (TSEBT) in female patients with large or pendulous breasts is usually associated with shaded inframammary folds. In this analysis, 18 patients with cutaneous malignancy and pendulous breasts were irradiated with a radiation bra and five patients received TSEBT without bra. All patients had moderate or severe sagging of the breasts. The median inframammary dose in the radiation bra group was 89% of the prescription dose versus 4% in the group without bra. The usage of the radiation bra enables an adequate radiation dose for the inframammary folds during TSEBT with no additional local irradiation.
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Affiliation(s)
- Isabel Falke
- Department of Radiation Oncology, University Hospital Munster, Munster, Germany
| | - Khaled Elsayad
- Department of Radiation Oncology, University Hospital Munster, Munster, Germany
| | - Mohammed Channaoui
- Department of Radiation Oncology, University Hospital Munster, Munster, Germany
- Department of Radiation Oncology, University Hospital Basel, Switzerland
| | - Christian Kandler
- Department of Radiation Oncology, University Hospital Munster, Munster, Germany
| | - Christos Moustakis
- Department of Radiation Oncology, University Hospital Munster, Munster, Germany
- Department of Radiation Oncology, University Medical Center Leipzig, Leipzig, Germany
| | - Hans Theodor Eich
- Department of Radiation Oncology, University Hospital Munster, Munster, Germany
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Alberti-Violetti S, Ardigò M, Massone C, Pileri A, Sala R, Teoli M, Grandi V, Quaglino P, Pimpinelli N, Berti E. Effectiveness and tolerability of chlormethine gel for the management of mycosis fungoides: a multicenter real-life evaluation. Front Oncol 2024; 13:1298296. [PMID: 38239642 PMCID: PMC10794371 DOI: 10.3389/fonc.2023.1298296] [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: 09/21/2023] [Accepted: 11/29/2023] [Indexed: 01/22/2024] Open
Abstract
Background Topical chlormethine (CL) is recommended as a first-line treatment for early-stage mycosis fungoides (MF) and in 2017, the European Medicines Agency approved the CL gel formulation to treat adult patients. More recently, to increase patient compliance and adherence, clinicians have developed flexible protocols that allow the concomitant use of CL gel with topical corticosteroids in daily practice regimens. Therefore, sharing real-life data on CL gel use and side effects management may help improve the use of this agent. Objectives To expand knowledge about the actual use of CL gel in patients with MF, the present study assessed the improvement of MF skin lesions after CL gel treatment and provided information on the management of cutaneous adverse events (AEs) in a real-life setting. Methods This was an Italian retrospective study conducted among six dermatology referral centers. Patients ≥18 years affected by MF and in treatment with CL gel (160 µ/g), alone or in combination according to routine clinical practice, between December 2019 and December 2021 were considered. The study's primary aim was to evaluate the effectiveness of CL gel in terms of overall response rate (ORR) after 3 months of treatment. Results A total of 79 patients (61% male) with different stages of MF (84% early stage) were included. CL gel was prescribed mainly in association with topical corticosteroids (66% of patients). ORR after 3 months of treatment was 42%, with no differences between early- and advanced-stage MF. Response rates improved over time up to 97% after 18 months of treatment. Overall, 66 AEs were reported in 67% of patients; most were hyperpigmentation (45%) and irritant contact dermatitis (37%). Six AEs led to treatment discontinuation, and five out of six (83%) patients who reported these events resumed treatment after interruption. No AEs were classified as severe. Conclusions Our observations support the use of CL gel in patients with early- and advanced-stage MF, making it a valuable treatment option.
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Affiliation(s)
- Silvia Alberti-Violetti
- Dermatology Unit, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Department of Pathophysiology and Transplantation, University of Milan, Milan, Italy
| | - Marco Ardigò
- San Gallicano Dermatological Institute IRCCS, Rome, Italy
| | - Cesare Massone
- Dermatology Unit & Scientific Directorate, Galliera Hospital, Genova, Italy
| | - Alessandro Pileri
- Dermatology, IRCCS Azienda Ospedaliera-Universitaria di Bologna, Policlinico di Sant’Orsola, Bologna, Italy
- Department of Medical and Surgical Sciences, Alma Mater Studiorum University of Bologna, Bologna, Italy
| | - Raffaella Sala
- Dermatology Unit, ASST Spedali Civili and University of Brescia, Brescia, Italy
| | - Miriam Teoli
- San Gallicano Dermatological Institute IRCCS, Rome, Italy
| | - Vieri Grandi
- Department of Health Sciences, Dermatology Unit, University of Florence, Florence, Italy
| | - Pietro Quaglino
- Department of Medical Sciences, Dermatology Clinic, University of Turin, Turin, Italy
| | - Nicola Pimpinelli
- Department of Health Sciences, Dermatology Unit, University of Florence, Florence, Italy
| | - Emilio Berti
- Dermatology Unit, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Department of Pathophysiology and Transplantation, University of Milan, Milan, Italy
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Latzka J, Assaf C, Bagot M, Cozzio A, Dummer R, Guenova E, Gniadecki R, Hodak E, Jonak C, Klemke CD, Knobler R, Morrris S, Nicolay JP, Ortiz-Romero PL, Papadavid E, Pimpinelli N, Quaglino P, Ranki A, Scarisbrick J, Stadler R, Väkevä L, Vermeer MH, Wehkamp U, Whittaker S, Willemze R, Trautinger F. EORTC consensus recommendations for the treatment of mycosis fungoides/Sézary syndrome - Update 2023. Eur J Cancer 2023; 195:113343. [PMID: 37890355 DOI: 10.1016/j.ejca.2023.113343] [Citation(s) in RCA: 20] [Impact Index Per Article: 20.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2023] [Revised: 07/28/2023] [Accepted: 08/23/2023] [Indexed: 10/29/2023]
Abstract
On behalf of the EORTC Cutaneous Lymphoma Tumours Group (EORTC-CLTG) and following up on earlier versions published in 2006 and 2017 this document provides an updated standard for the treatment of mycosis fungoides and Sézary syndrome (MF/SS). It considers recent relevant publications and treatment options introduced into clinical practice after 2017. Consensus was established among the authors through a series of consecutive consultations in writing and a round of discussion. Treatment options are assigned to each disease stage and, whenever possible and clinically useful, separated into first- and second line options annotated with levels of evidence. Major changes to the previous version include the incorporation of chlormethine, brentuximab vedotin, and mogamulizumab, recommendations on the use of pegylated interferon α (after withdrawal of recombinant unpegylated interferons), and the addition of paragraphs on supportive therapy and on the care of older patients. Still, skin-directed therapies are the most appropriate option for early-stage MF and most patients have a normal life expectancy but may suffer morbidity and impaired quality of life. In advanced disease treatment options have expanded recently. Most patients receive multiple consecutive therapies with treatments often having a relatively short duration of response. For those patients prognosis is still poor and only for a highly selected subset long term remission can be achieved with allogeneic stem cell transplantation. Understanding of the disease, its epidemiology and clinical course, and its most appropriate management are gradually advancing, and there is well-founded hope that this will lead to further improvements in the care of patients with MF/SS.
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Affiliation(s)
- Johanna Latzka
- Department of Dermatology and Venereology, University Hospital of St. Pölten, Karl Landsteiner University of Health Sciences, St. Pölten, Austria; Karl Landsteiner Institute of Dermatological Research, Department of Dermatology and Venereology, University Hospital of St. Pölten, St. Pölten, Austria.
| | - Chalid Assaf
- Department of Dermatology, HELIOS Klinikum Krefeld, Krefeld, Germany; Institute for Molecular Medicine, Medical School Hamburg, University of Applied Sciences and Medical University, Hamburg, Germany; Department of Dermatology, HELIOS Klinikum Schwerin, University Campus of The Medical School Hamburg, Schwerin, Germany
| | - Martine Bagot
- Department of Dermatology, Hopital Saint Louis, Université Paris Cité, INSERM U976, Paris, France
| | - Antonio Cozzio
- Department of Dermatology and Allergology, Kantonspital St. Gallen, St. Gallen, Switzerland
| | - Reinhard Dummer
- Department of Dermatology, University of Zurich, Zurich, Switzerland
| | - Emmanuella Guenova
- Department of Dermatology, University Hospital of Lausanne and Faculty of Biology and Medicine, University of Lausanne, Lausanne, Switzerland
| | - Robert Gniadecki
- Department of Dermatology, University of Copenhagen, Copenhagen, Denmark; Division of Dermatology, Department of Medicine, University of Alberta, Edmonton, Alberta, Canada
| | - Emmilia Hodak
- Cutaneous Lymphoma Unit, Davidoff Cancer Center, Rabin Medical Center, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Constanze Jonak
- Department of Dermatology, Medical University of Vienna, Vienna, Austria
| | | | - Robert Knobler
- Department of Dermatology, Medical University of Vienna, Vienna, Austria
| | - Stephen Morrris
- Guy's and St Thomas' NHS Foundation Trust, Guy's Hospital, London, UK
| | - Jan P Nicolay
- Department of Dermatology, Venereology and Allergology, University Medical Center Mannheim, Mannheim, Germany
| | - Pablo L Ortiz-Romero
- Department of Dermatology, Hospital Universitario 12 de Octubre, Institute i+12, CIBERONC, Medical School, University Complutense, Madrid, Spain
| | - Evangelia Papadavid
- National and Kapodistrian University of Athens, 2nd Department of Dermatology and Venereology, Attikon General Hospital, University of Athens, Chaidari, Greece
| | - Nicola Pimpinelli
- Department of Health Sciences, Division of Dermatology, University of Florence, Florence, Italy
| | - Pietro Quaglino
- Department of Medical Sciences, Section of Dermatology, University of Turin, Turin, Italy
| | - Annamari Ranki
- Department of Dermatology and Allergology, Inflammation Center, Helsinki University Central Hospital, Helsinki, Finland
| | - Julia Scarisbrick
- Department of Dermatology, University Hospital Birmingham, Birmingham, UK
| | - Rudolf Stadler
- University Department of Dermatology, Venereology, Allergology and Phlebology, Skin Cancer Center, Johannes Wesling Medical Centre Minden, Ruhr University Bochum, Bochum, Germany
| | - Liisa Väkevä
- Department of Dermatology and Allergology, Inflammation Center, Helsinki University Central Hospital, Helsinki, Finland
| | - Maarten H Vermeer
- Department of Dermatology, Leiden University Medical Center, Leiden, the Netherlands
| | - Ulrike Wehkamp
- Department of Dermatology, University Hospital Schleswig-Holstein, Campus Kiel, Kiel, Germany; Medical Department, Medical School of Hamburg, Hamburg, Germany
| | - Sean Whittaker
- St. John's Institute of Dermatology, School of Basic and Medical Biosciences, Faculty of Life Sciences and Medicine, King's College London, London, UK
| | - Rein Willemze
- Department of Dermatology, Leiden University Medical Center, Leiden, the Netherlands
| | - Franz Trautinger
- Department of Dermatology and Venereology, University Hospital of St. Pölten, Karl Landsteiner University of Health Sciences, St. Pölten, Austria; Karl Landsteiner Institute of Dermatological Research, Department of Dermatology and Venereology, University Hospital of St. Pölten, St. Pölten, Austria
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Elsayad K, Eich HT. The evolving role of reduced-dose total skin electron beam therapy in skin malignancies: the renaissance of a rare indication. Strahlenther Onkol 2023; 199:950-953. [PMID: 37449991 PMCID: PMC10542725 DOI: 10.1007/s00066-023-02115-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2023] [Accepted: 06/23/2023] [Indexed: 07/18/2023]
Abstract
Definitive radiation therapy is an effective local treatment for several cutaneous malignancies. Patients with diffuse or generalized skin manifestations might require total skin electron beam therapy (TSEBT) as an alternative treatment to the chasing technique. In this short communication, we highlight the evolving role of TSEBT and present its role in various forms of skin malignancies.
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Affiliation(s)
- Khaled Elsayad
- Department of Radiation Oncology, University Hospital of Muenster, Building A1, 1 Albert Schweitzer Campus, 48149, Münster, Germany
| | - Hans Theodor Eich
- Department of Radiation Oncology, University Hospital of Muenster, Building A1, 1 Albert Schweitzer Campus, 48149, Münster, Germany.
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Kouhen F, Oqbani K, El Gouach H, Ahnach M, Dahbi Z. Overcoming Chemotherapy Resistance in Cutaneous T-Cell Lymphoma: A Successful Case of High-Dose Radiotherapy Management. Cureus 2023; 15:e43959. [PMID: 37746484 PMCID: PMC10514740 DOI: 10.7759/cureus.43959] [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] [Accepted: 08/23/2023] [Indexed: 09/26/2023] Open
Abstract
The management of refractory cutaneous T-cell lymphoma (CTCL) is challenging and requires a multimodal approach. Radiotherapy is one of the treatment options used in managing CTCL, particularly for localized disease or as a palliative measure to control symptoms in advanced cases. The rarity of the disease makes it difficult to conduct extensive clinical trials and gather sufficient data on the most effective treatment approaches. Lymphocytes are among the most sensitive cells to radiation's damaging effects. Because of this sensitivity, radiation therapy can be an effective treatment. This case illustrates the efficacy of radiotherapy and its potential as an effective treatment alternative for a severe and resistant CTCL to systemic therapy in a 61-year-old Moroccan patient. The patient underwent curative high-dose radiation therapy, utilizing three-dimensional conformal radiation therapy. At the 19-month follow-up post-radiotherapy, no evidence of local recurrence, either clinically or radiologically, was observed, and the patient maintained a good quality of life with unrestricted mobility of his arm.
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Affiliation(s)
- Fadila Kouhen
- Laboratory of Neurosciences and Oncogenetics, Department of Radiotherapy, Mohammed VI Center for Research and Innovation, International University Hospital Sheikh Khalifa, Mohammed VI University of Sciences and Health (UM6SS), Casablanca, MAR
| | - Kenza Oqbani
- Department of Pathology, International University Hospital Sheikh Khalifa, Mohammed VI University of Sciences and Health (UM6SS), Casablanca, MAR
| | - Hanae El Gouach
- Laboratory of Neurosciences and Oncogenetics, Department of Radiotherapy, Mohammed VI Center for Research and Innovation, International University Hospital Sheikh Khalifa, Mohammed VI University of Sciences and Health (UM6SS), Casablanca, MAR
| | - Meriem Ahnach
- Department of Hematology, International University Hospital Sheikh Khalifa, Mohammed VI University of Sciences and Health (UM6SS), Casablanca, MAR
| | - Zineb Dahbi
- Department of Radiotherapy, International University Hospital Sheikh Khalifa, Mohammed VI University of Sciences and Health (UM6SS), Casablanca, MAR
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Total Skin Treatment with Helical Arc Radiotherapy. Int J Mol Sci 2023; 24:ijms24054492. [PMID: 36901922 PMCID: PMC10002962 DOI: 10.3390/ijms24054492] [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: 01/14/2023] [Revised: 02/19/2023] [Accepted: 02/20/2023] [Indexed: 03/02/2023] Open
Abstract
For widespread cutaneous lymphoma, such as mycosis fungoides or leukemia cutis, in patients with acute myeloid leukemia (AML) and for chronic myeloproliferative diseases, total skin irradiation is an efficient treatment modality for disease control. Total skin irradiation aims to homogeneously irradiate the skin of the entire body. However, the natural geometric shape and skin folding of the human body pose challenges to treatment. This article introduces treatment techniques and the evolution of total skin irradiation. Articles on total skin irradiation by helical tomotherapy and the advantages of total skin irradiation by helical tomotherapy are reviewed. Differences among each treatment technique and treatment advantages are compared. Adverse treatment effects and clinical care during irradiation and possible dose regimens are mentioned for future prospects of total skin irradiation.
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Baba MH, Singh BK, Wani SQ. In vivo Dosimetry for Dose Verification of Total Skin Electron Beam Therapy Using Gafchromic® EBT3 Film Dosimetry. J Med Phys 2022; 47:362-366. [PMID: 36908494 PMCID: PMC9997533 DOI: 10.4103/jmp.jmp_72_22] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2022] [Revised: 09/30/2022] [Accepted: 10/16/2022] [Indexed: 01/11/2023] Open
Abstract
Background and Purpose Total skin electron beam therapy (TSEBT) is an important skin-directed radiotherapeutic procedure done in the treatment of cutaneous T-cell lymphomas, namely, mycosis fungoides (MF). This procedure is usually done at larger source-to-surface distances with the patient standing on a rotatory platform. As the patient has to stand in different positions without any rigid immobilization devices, there are chances that the total skin may not get uniformly irradiated which could lead to nonuniform dose distributions. Therefore, all the necessary arrangements should be made to evaluate the dose for different regions of the skin using suitable in vivo dosimeters at the radiotherapy centers offering these treatments. This study aimed to evaluate the consistency between the delivered and planned doses in vivo during TSEBT using Gafchromic EBT3 film dosimetry. Materials and Methods The surface dose for the six MF patients treated for TSEBT at our hospital from 2018 to 2022 was measured and evaluated. 2 cm × 2 cm Gafchromic® EBT3 films were used to measure skin dose at reference body positions of clinical interest. All the patients were treated with the modified Stanford technique. The irradiated film strips were analyzed for the dose using the IMRT OmniPro software. The doses at respective positions were expressed as mean dose ± standard deviation and the deviation was calculated as the percentage of the prescribed dose. Results One hundred and fifty-four Gafchromic® EBT3 film strips irradiated on six TSEBT patients showed a maximum dose variation of 2.00 ± 0.14 Gy, in the central body regions. The dose variation in the peripheral areas such as hands and ears was larger. A variation of 2 ± 0.32 Gy was observed on the hands and ears. The uniformity of the dose delivered to maximum body parts was within -7% and +16% for the peripheral areas like hands. The American Association of Physicists in Medicine recommends a dose uniformity of 8% and 4% in the vertical and horizontal patient plane for direct incident beam; however, for oblique incidences like in the modified Stanford technique, the dose variation is about 15%. Conclusion In vivo dosimetry using Gafchromic EBT3 film dosimetry for TSEBT yields objective data to find the under or overdose regions. That can be useful to provide quality treatment, especially when treatments tend to be as complex as TSEBT.
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Affiliation(s)
- Misba Hamid Baba
- Department of Physics, Institute of Applied Sciences and Humanities, GLA University, Mathura, Uttar Pradesh, India
- Department of Radiological Physics and B.E, Sher I Kashmir Institute of Medical Sciences, Srinagar, Jammu and Kashmir, India
| | - Benoy Kumar Singh
- Department of Physics, Institute of Applied Sciences and Humanities, GLA University, Mathura, Uttar Pradesh, India
| | - Shaqul Qamar Wani
- Department of Radiation Oncology, Sher I Kashmir Institute of Medical Sciences, Srinagar, Jammu and Kashmir, India
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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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Elsayad K, Rolf D, Sunderkötter C, Weishaupt C, Müller EC, Nawar T, Stranzenbach R, Livingstone E, Stadler R, Steinbrink K, Moritz RKC, Eich HT. Niedrig dosierte Ganzhautelektronenbestrahlung mit oraler Bexaroten-Erhaltungstherapie beim kutanen T-Zell-Lymphom. J Dtsch Dermatol Ges 2022; 20:279-286. [PMID: 35304957 DOI: 10.1111/ddg.14657_g] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2021] [Accepted: 09/13/2021] [Indexed: 12/17/2022]
Affiliation(s)
- Khaled Elsayad
- Klinik für Strahlentherapie und Radioonkologie, Universitätsklinikum Münster
| | - Daniel Rolf
- Klinik für Strahlentherapie und Radioonkologie, Universitätsklinikum Münster
| | - Cord Sunderkötter
- Universitätsklinik und Poliklinik für Dermatologie und Venerologie - Universitätsklinikum Halle
| | | | | | - Tarek Nawar
- Klinik für Strahlentherapie und Radioonkologie, Universitätsklinikum Münster
| | - Rene Stranzenbach
- Klinik für Dermatologie, Venerologie und Allergologie, Universitätsklinikum Bochum
| | | | - Rudolf Stadler
- Universitätsklinik für Dermatologie, Venerologie, Allergologie und Phlebologie, Johannes Wesling Klinikum Minden, Universität Bochum, Minden
| | | | - Rose K C Moritz
- Universitätsklinik und Poliklinik für Dermatologie und Venerologie - Universitätsklinikum Halle
| | - Hans Theodor Eich
- Klinik für Strahlentherapie und Radioonkologie, Universitätsklinikum Münster
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Elsayad K, Rolf D, Sunderkötter C, Weishaupt C, Müller EC, Nawar T, Stranzenbach R, Livingstone E, Stadler R, Steinbrink K, Moritz RKC, Eich HT. Low-dose total skin electron beam therapy plus oral bexarotene maintenance therapy for cutaneous T-cell lymphoma. J Dtsch Dermatol Ges 2022; 20:279-285. [PMID: 34984837 DOI: 10.1111/ddg.14657] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2021] [Accepted: 09/13/2021] [Indexed: 12/24/2022]
Abstract
BACKGROUND Total skin electron beam therapy (TSEBT) combined with systemic therapy or maintenance treatment is a reasonable approach to enhance the remission rate and duration in mycosis fungoides (MF) and Sézary syndrome (SS). This study assesses the efficacy of oral bexarotene therapy after low-dose TSEBT for patients with MF and SS. METHODS In this prospective observational study, we recruited MF/SS patients for treatment with low-dose total skin electron beam therapy (TSEBT) with or without bexarotene therapy to describe outcomes and toxicities. RESULTS Forty-six subjects with MF or SS underwent TSEBT between 2016 and 2021 at our institute. Following TSEBT, 27 patients (59 %) received oral bexarotene treatment. The median follow-up was 13 months. The overall response rate (ORR) for the cohort was 85 %. The response rate was significantly higher with combined modality (CM) than TSEBT alone (96 % vs. 68 %, p = 0.03). Median progression-free survival (PFS) for the CM was 17 months versus five months following TSEBT alone (p = 0.001). One patient (4 %) in the retinoid group discontinued the bexarotene therapy because of adverse events. The administration of bexarotene therapy did not increase radiation-related toxicities. CONCLUSIONS Response rate and progression-free survival might be improved with TSEBT in combination with oral bexarotene compared to TSEBT alone.
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Affiliation(s)
- Khaled Elsayad
- Department of Radiation Oncology, University Hospital of Muenster, Munster, Germany
| | - Daniel Rolf
- Department of Radiation Oncology, University Hospital of Muenster, Munster, Germany
| | - Cord Sunderkötter
- Department of Dermatology and Venerology, Martin-Luther-University Halle-Wittenberg, Halle, Germany
| | - Carsten Weishaupt
- Department of Dermatology, University Hospital of Muenster, Munster, Germany
| | | | - Tarek Nawar
- Department of Radiation Oncology, University Hospital of Muenster, Munster, Germany
| | - Rene Stranzenbach
- Department of Dermatology, University Hospital of Bochum, Bochum, Germany
| | | | - Rudolf Stadler
- Department of Dermatology, Johannes Wesling Medical Centre, University of Bochum, Minden, German
| | - Kerstin Steinbrink
- Department of Dermatology, University Hospital of Muenster, Munster, Germany
| | - Rose K C Moritz
- Department of Dermatology and Venerology, Martin-Luther-University Halle-Wittenberg, Halle, Germany
| | - Hans Theodor Eich
- Department of Radiation Oncology, University Hospital of Muenster, Munster, Germany
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Baghani HR, Robatjazi M, Andreoli S. Comparing the dosimeter-specific corrections for influence quantities of some parallel-plate ionization chambers in conventional electron beam dosimetry. Appl Radiat Isot 2021; 179:110031. [PMID: 34801928 DOI: 10.1016/j.apradiso.2021.110031] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2021] [Revised: 11/06/2021] [Accepted: 11/14/2021] [Indexed: 11/28/2022]
Abstract
The performance characteristics of some widely employed parallel-plate ionization chambers in dosimetry of conventional high energy electron beams were evaluated and compared in the present study following the recommendations of the IAEA TRS-398 reference dosimetry protocol. Three different types of PTW-made parallel-plate ionization chambers including Roos (TM34001), Markus (TM23343), and Advanced Markus (TM34045) were employed, and correction factors for polarity (kpol), recombination (ks), and quality conversion factor ( [Formula: see text] ) were determined at different nominal electron energies of 4, 6, 9, 12, 16, and 20 MeV produced by a Varian Trilogy clinical Linac. All measurements were performed inside a MP3-M automatic water phantom in the reference condition of 100 cm SSD (source to surface distance), reference measurement depth (zref), and 10 × 10 cm2 field size at the phantom surface. The maximum and minimum range of kpol deviations from unity were respectively found for Markus and Roos ionization chambers. The maximum ks values also belonged to the Markus ionization chamber, while the minimum ks values were observed for the Advanced Markus chamber. The measured ks values through recommendations of the TRS-398 dosimetry protocol were in good accordance with those obtained by Jaffe-plot analysis for all considered ionization chambers. The type of employed ionization chamber can minimally affect the measured electron beam quality index (R50), while it can have a more considerable impact on [Formula: see text] value, especially in the case of the Markus chamber. From the results, it can be concluded that the Roos and Advanced Markus ionization chambers have a superior performance in the case of electron beam dosimetry, although all considered ionization chambers fulfilled the criteria requested by relevant reference dosimetry protocols.
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Affiliation(s)
| | - Mostafa Robatjazi
- Medical Physics and Radiological Sciences Department, Sabzevar University of Medical Sciences, Sabzevar, Iran; Non-Communicable Diseases Research Center, Sabzevar University of Medical Sciences, Sabzevar, Iran
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Oertel M, Elsayad K, Engenhart-Cabillic R, Reinartz G, Baues C, Schmidberger H, Vordermark D, Marnitz S, Lukas P, Ruebe C, Engert A, Lenz G, Eich HT. Radiation treatment of hemato-oncological patients in times of the COVID-19 pandemic : Expert recommendations from the radiation oncology panels of the German Hodgkin Study Group and the German Lymphoma Alliance. Strahlenther Onkol 2020; 196:1096-1102. [PMID: 33125504 PMCID: PMC7596809 DOI: 10.1007/s00066-020-01705-w] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2020] [Accepted: 10/22/2020] [Indexed: 02/06/2023]
Abstract
PURPOSE The coronavirus pandemic is affecting global health systems, endangering daily patient care. Hemato-oncological patients are particularly vulnerable to infection, requiring decisive recommendations on treatment and triage. The aim of this survey amongst experts on radiation therapy (RT) for lymphoma and leukemia is to delineate typical clinical scenarios and to provide counsel for high-quality care. METHODS A multi-item questionnaire containing multiple-choice and free-text questions was developed in a peer-reviewed process and sent to members of the radiation oncology panels of the German Hodgkin Study Group and the German Lymphoma Alliance. Answers were assessed online and analyzed centrally. RESULTS Omission of RT was only considered in a minority of cases if alternative treatment options were available. Hypofractionated regimens and reduced dosages may be used for indolent lymphoma and fractures due to multiple myeloma. Overall, there was a tendency to shorten RT rather than to postpone or omit it. Even in case of critical resource shortage, panelists agreed to start emergency RT for typical indications (intracranial pressure, spinal compression, superior vena cava syndrome) within 24 h. Possible criteria to consider for patient triage are the availability of (systemic) options, the underlying disease dynamic, and the treatment rationale (curative/palliative). CONCLUSION RT for hemato-oncological patients receives high-priority and should be maintained even in later stages of the pandemic. Hypofractionation and shortened treatment schedules are feasible options for well-defined constellations, but have to be discussed in the clinical context.
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Affiliation(s)
- M Oertel
- Department of Radiation Oncology, University Hospital Muenster, Albert-Schweitzer-Campus 1 building A1, 48149, Muenster, Germany
| | - K Elsayad
- Department of Radiation Oncology, University Hospital Muenster, Albert-Schweitzer-Campus 1 building A1, 48149, Muenster, Germany
| | - R Engenhart-Cabillic
- Department of Radiotherapy and Radiation Oncology, University Hospital Giessen-Marburg, Marburg, Germany
| | - G Reinartz
- Department of Radiation Oncology, University Hospital Muenster, Albert-Schweitzer-Campus 1 building A1, 48149, Muenster, Germany
| | - C Baues
- Department of Radiation Oncology and Cyberknife Center, University Hospital of Cologne, Cologne, Germany
| | - H Schmidberger
- Department of Radiotherapy and Radiation Oncology, University Hospital Mainz, Mainz, Germany
| | - D Vordermark
- Department of Radiation Oncology, University Hospital Halle (Saale), Halle (Saale), Germany
| | - S Marnitz
- Department of Radiation Oncology and Cyberknife Center, University Hospital of Cologne, Cologne, Germany
| | - P Lukas
- Department of Radiooncology, Medical University Innsbruck, Innsbruck, Austria
| | - C Ruebe
- Department of Radiation Oncology, Saarland University Hospital, Homburg, Germany
| | - A Engert
- Department I of Internal Medicine, Center for Integrated Oncology Aachen Bonn Cologne Düsseldorf, University Hospital of Cologne, Cologne, Germany
| | - G Lenz
- Department of Medicine A, Hematology, Oncology, University Hospital Muenster, Muenster, Germany
| | - H T Eich
- Department of Radiation Oncology, University Hospital Muenster, Albert-Schweitzer-Campus 1 building A1, 48149, Muenster, Germany.
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Rolf D, Elsayad K, Eich HT. Acute and sub-acute toxicity profile of ultra-hypofractionated low-dose total skin electron beam with two 4 Gy fractions for cutaneous T cell lymphoma. J Cancer Res Clin Oncol 2020; 147:1757-1761. [PMID: 33219856 PMCID: PMC7680066 DOI: 10.1007/s00432-020-03449-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2020] [Accepted: 10/31/2020] [Indexed: 12/14/2022]
Abstract
Purpose Low-dose total skin electron beam therapy (TSEBT) over 3 weeks has proved to be a safe and effective treatment for cutaneous T cell lymphomas (CTCL). In this prospective trial, we examined the feasibility of ultra-hypofractionated low-dose TSEBT regimen in two fractions with 4 Gy combined with systemic therapy to minimize the number of visits to radiation centers. Patients and methods Six patients with mycosis fungoides (MF) or Sézary syndrome (SS) received TSEBT with a total radiation dose of 8 Gy in two fractions between April 2020 and June 2020. Patient and treatment characteristics, tumor burden, the impact on the quality of life using Skindex-29 questionnaires, and acute toxicities were analyzed. Results During TSEBT, all patients developed grade 1 toxicities while two patients developed grade 2 toxicities. One patient experienced sepsis. The most common adverse effects were erythema and edema. All grade 2 toxicities regressed after 4 weeks following TSEBT. Based on the reported symptoms measured by Skindex-29, we detected a significant reduction in total Skindex-29 score after 8 weeks of radiation (P = 0.03), particularly in the symptoms (P = 0.01) and emotional domains (P = 0.04). Conclusion Ultra-hypofractionated low-dose TSEBT followed by systemic therapy seems to be a safe and feasible alternative to conventional fractionated TSEBT for patients with MF/SS. The skin tumor burden and the health-related quality of life have been significantly improved within 8 weeks following radiotherapy.
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Affiliation(s)
- Daniel Rolf
- Department of Radiation Oncology, University Hospital of Muenster, Building A1, 1 Albert Schweitzer Campus, 48149, Muenster, Germany
| | - Khaled Elsayad
- Department of Radiation Oncology, University Hospital of Muenster, Building A1, 1 Albert Schweitzer Campus, 48149, Muenster, Germany.
| | - Hans Theodor Eich
- Department of Radiation Oncology, University Hospital of Muenster, Building A1, 1 Albert Schweitzer Campus, 48149, Muenster, Germany
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14
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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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Elsayad K, Stadler R, Steinbrink K, Eich HT. Kombination von Ganzhautbestrahlung und Immuncheckpoint‐Inhibitoren: Eine vielversprechende Therapieoption bei Mycosis fungoides und Sézary‐Syndrom. J Dtsch Dermatol Ges 2020; 18:193-198. [PMID: 32130771 DOI: 10.1111/ddg.14044_g] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2019] [Accepted: 08/16/2019] [Indexed: 12/20/2022]
Affiliation(s)
- Khaled Elsayad
- Klinik für Strahlentherapie, Universitätsklinikum Münster
| | - Rudolf Stadler
- Universitätsklinik für Dermatologie, Venerologie, Allergologie und Phlebologie, Johannes Wesling-Klinikum Minden
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16
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Elsayad K, Stadler R, Steinbrink K, Eich HT. Combined total skin radiotherapy and immune checkpoint inhibitors: A promising potential treatment for mycosis fungoides and Sezary syndrome. J Dtsch Dermatol Ges 2020; 18:193-197. [DOI: 10.1111/ddg.14044] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2019] [Accepted: 08/16/2019] [Indexed: 12/31/2022]
Affiliation(s)
- Khaled Elsayad
- Department of Radiation OncologyUniversity Hospital Muenster Muenster Germany
| | - Rudolf Stadler
- Department of DermatologyJohannes Wesling Klinikum Minden Minden Germany
| | | | - Hans Theodor Eich
- Department of Radiation OncologyUniversity Hospital Muenster Muenster Germany
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17
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Elsayad K, Kroeger K, Greve B, Moustakis C, Assaf C, Stadler R, Lenz G, Weishaupt C, Eich HT. Low-dose total skin electron beam therapy: Quality of life improvement and clinical impact of maintenance and adjuvant treatment in patients with mycosis fungoides or Sezary syndrome. Strahlenther Onkol 2019; 196:77-84. [PMID: 31591658 DOI: 10.1007/s00066-019-01517-7] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2019] [Accepted: 09/10/2019] [Indexed: 12/11/2022]
Abstract
PURPOSE Total skin electron beam therapy (TSEBT) has proved to be a safe and effective treatment for cutaneous T‑cell lymphomas. Here, we examined the impact of this treatment on patient quality of life and outcome. PATIENTS AND METHODS Forty-four patients with mycosis fungoides (MF) or Sezary syndrome (SS) received 48 TSEBT courses with a median dose of 12 Gy within the past 8 years at our institute. Patient and treatment characteristics for these cases as well as the impact of TSEBT on quality of life and duration of response were retrospectively analyzed and compared. RESULTS The median modified Severity-Weighted Assessment Tool score before the start of TSEBT was 44. The overall response rate was 88%, with a complete response (CR) rate of 33%. The median follow-up period was 13 months. The median duration of response (DOR) and progression-free survival (PFS) for the entire cohort were 10 months and 9 months, respectively. Patient-reported symptom burden was measured with the Dermatological Life Quality Index and Skindex-29 questionnaires. The mean symptom reductions were 6 ± 8 (P = 0.005) and 21 ± 24 (P = 0.002), respectively. In the Functional Assessment of Cancer Therapy-General Assessment, significant improvements in the emotional (P = 0.03) domains were observed after TSEBT. Patients who received maintenance or adjuvant treatments had a longer PFS (P = 0.01). CONCLUSION TSEBT improved disease symptoms and significantly improved emotional domains of patients' quality of life in patients with MF or SS. In addition, our results indicate that maintenance or adjuvant therapy after TSEBT may improve the PFS.
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Affiliation(s)
- Khaled Elsayad
- Department of Radiation Oncology, University Hospital Muenster, Building A1, 1 Albert-Schweitzer-Campus, 48149, Muenster, Germany.
| | - Kai Kroeger
- Department of Radiation Oncology, University Hospital Muenster, Building A1, 1 Albert-Schweitzer-Campus, 48149, Muenster, Germany
| | - Burkhard Greve
- Department of Radiation Oncology, University Hospital Muenster, Building A1, 1 Albert-Schweitzer-Campus, 48149, Muenster, Germany
| | - Christos Moustakis
- Department of Radiation Oncology, University Hospital Muenster, Building A1, 1 Albert-Schweitzer-Campus, 48149, Muenster, Germany
| | - Chalid Assaf
- Department of Dermatology, Helios Klinikum, Krefeld, Germany
| | - Rudolf Stadler
- Department of Dermatology, Johannes-Wesling-Klinikum Minden, Minden, Germany
| | - Georg Lenz
- Department of Medicine A, University Hospital Muenster, Muenster, Germany
| | - Carsten Weishaupt
- Department of Dermatology, University Hospital Muenster, Muenster, Germany
| | - Hans Theodor Eich
- Department of Radiation Oncology, University Hospital Muenster, Building A1, 1 Albert-Schweitzer-Campus, 48149, Muenster, Germany
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18
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Nashan D, Friedrich CM, Geissler E, Schmitt-Graeff A, Klein F, Meiss F. [Primary cutaneous lymphoma-a case series of 163 patients]. Hautarzt 2019; 69:1014-1020. [PMID: 29881891 DOI: 10.1007/s00105-018-4212-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND In addition to a broad and clinically diverse spectrum of known primary cutaneous lymphomas, for which an incidence of 1-3:100,000 is postulated, each year further entities are specified and defined. The goal is the presentation of a case series from daily clinical routine. METHODS Over a period of 6 years and 2 months, patients consulting the Department of Dermatology, Medical Center University of Freiburg, were registered. Subsequently, collectives of mycosis fungoides (MF), Sezary syndrome (SS), CD30+ lymphoproliferative diseases, single cases with rare primary cutaneous lymphomas, and subcollectives of B‑cell lymphomas were examined. The high number of MF cases allowed the additional quantitative analyses of the types of therapies used in this group. RESULTS Yearly 16-25 new diagnoses of primary cutaneous lymphoma are made. The evaluation of 163 primary cutaneous lymphoma revealed 111 cases with MF (68.1%), including 9 particular variants, 15 primary cutaneous CD30+ lymphoproliferative diseases (9.2%) dominated by 10 lymphomatoid papulosis (LyP), in addition to 5 primary cutaneous anaplastic large cell lymphoma (PCALCL), 6 SS (3.68%), and 24 cutaneous B‑cell lymphomas (14-72%). Three cases with rare primary cutaneous T/NK cell lymphomas are addressed in detail. In all, 82% of MF cases were stage IA and IB. The descending use of therapies for stage I-III included steroids and diverse UV therapies followed by bexarotene, interferon-α, methotrexate, and extracorporal photophoresis. CONCLUSIONS Diagnoses of cutaneous lymphomas belong to a vast spectrum of differential diagnoses. This registry describes frequent findings and shows rare variants. You can only diagnose what you know; accordingly, a collection of case reports, which we wish to encourage, can help in processing and specification of entities.
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Affiliation(s)
- D Nashan
- Hautklinik, Klinikum Dortmund gGmbH, Beurhausstr. 40, 44137, Dortmund, Deutschland.
| | - C M Friedrich
- Fachhochschule Dortmund - Fachbereich Informatik und Institut für Medizinische Informatik, Biometrie und Epidemiologie (IMIBE), Universitätsklinikum Essen, Essen, Deutschland
| | - E Geissler
- Hautklinik, Klinikum Ludwigshafen, Ludwighafen, Deutschland
| | - A Schmitt-Graeff
- Institut für Klinische Pathologie, Universitätsklinikum Freiburg, Freiburg, Deutschland
- Medizinische Fakultät, Albert-Ludwigs-Universität, Freiburg, Deutschland
| | - F Klein
- Wissenschaftliche Fachkommunikation, München, Deutschland
| | - F Meiss
- Klinik für Dermatologie und Venerologie, Universitätsklinikum Freiburg, Freiburg, Deutschland
- Medizinische Fakultät, Albert-Ludwigs-Universität, Freiburg, Deutschland
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19
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King BJ, Lester SC, Tolkachjov SN, Davis MDP, Gibson LE, Martenson JA. Skin-directed radiation therapy for cutaneous lymphoma: The Mayo Clinic experience. J Am Acad Dermatol 2019; 82:634-641. [PMID: 31344376 DOI: 10.1016/j.jaad.2019.07.040] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2018] [Revised: 07/07/2019] [Accepted: 07/11/2019] [Indexed: 11/16/2022]
Abstract
BACKGROUND Focal or total skin radiation therapy can be used to treat mild to refractory cutaneous T-cell lymphoma. OBJECTIVE To report the broad therapeutic benefit of radiation therapy for cutaneous T-cell lymphoma. METHODS Retrospective, single-institution review of outcomes for skin-directed radiation therapy. RESULTS Skin-directed radiation therapy showed a 99% response rate and 80% complete response rate after treatment regardless of involvement, severity, histopathologic subtype, dose, or fractionation. The overall in-field recurrence rate was 15%, and median time to recurrence was 296 days (range, 1-1884 days). Focal and hypofractionated regimens were similarly associated with disease response and rare toxicity. Short-term rates of secondary skin cancer after treatment were comparable to expected incidence in a patient population without radiation. LIMITATIONS Large total number of treatments courses compared with overall number of patients. Heterogenous mix of treatment regimens (no standardization of dose or fraction number). CONCLUSIONS Radiation therapy is a well-tolerated treatment option for properly selected patients with cutaneous T-cell lymphoma.
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Affiliation(s)
- Brian J King
- Department of Dermatology, Mayo Clinic, Rochester, Minnesota; Surgical Dermatology Group, Birmingham, Alabama.
| | - Scott C Lester
- Department of Radiation Oncology, Mayo Clinic, Rochester, Minnesota
| | | | - Mark D P Davis
- Department of Dermatology, Mayo Clinic, Rochester, Minnesota
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20
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Photons Without Bolus Versus Electrons With Bolus After Upfront Mastectomy Without Immediate Reconstruction in Breast Cancer Patients. Int J Radiat Oncol Biol Phys 2019; 104:877-884. [DOI: 10.1016/j.ijrobp.2019.03.029] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2019] [Revised: 03/13/2019] [Accepted: 03/16/2019] [Indexed: 11/20/2022]
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21
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Diffuse Primary Cutaneous Anaplastic Large Cell Lymphoma Treated by Rotational Total Skin Electron Beam Radiotherapy with Custom Shielding: Case Report. J Med Imaging Radiat Sci 2019; 50:454-459. [PMID: 31213358 DOI: 10.1016/j.jmir.2019.05.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2019] [Revised: 04/26/2019] [Accepted: 05/14/2019] [Indexed: 11/23/2022]
Abstract
INTRODUCTION Primary cutaneous anaplastic large cell lymphoma (PCALCL) is a rare T-cell malignancy typically presenting as a solitary lesion treated with radiotherapy. Diffuse PCALCL is rare, and treatment paradigms of diffuse PCALCL are poorly defined. CASE AND OUTCOMES In this report, a 69-year-old male presented with progressive extensive truncal PCALCL resistant to brentuximab. The truncal lesions were treated with 36 Gy in 18 fractions by a novel approach using rotational electron beam radiation therapy with custom-made shielding. The treatment was well tolerated with expected dermatologic side effects managed supportively. All lesions achieved an initial complete response, and two sites within the treatment field recurred five months after treatment. DISCUSSION This case adds to the limited literature on diffuse PCALCL and demonstrates an uncommon treatment approach to multifocal PCALCL using rotational electron beam radiation therapy with personalized shielding techniques. The treatment approach here was well tolerated by the patient with initial complete response at all sites. Maximal sparing was especially critical in this patient because of a history of previous head and neck irradiation. Shielded areas were validated by optically stimulated luminescent dosimeters showing dose reduction, confirming the utility of this method. CONCLUSION Rotational total skin electron beam with personalized shielding may be generalizable to cutaneous malignancies including PCALCL presenting with diffuse skin involvement. Further investigation of diffuse PCALCL is merited to optimize treatment strategies.
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22
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Rivers CI, Singh AK. Total Skin Electron Beam Therapy for Mycosis Fungoides Revisited With Adjuvant Systemic Therapy. CLINICAL LYMPHOMA MYELOMA & LEUKEMIA 2018; 19:83-88. [PMID: 30528417 DOI: 10.1016/j.clml.2018.11.015] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/31/2018] [Revised: 11/01/2018] [Accepted: 11/09/2018] [Indexed: 10/27/2022]
Abstract
BACKGROUND Although standard-dose total skin electron beam therapy (TSEBT) has been thought to provide the greatest clinical benefit for mycosis fungoides, recent studies have shown that low-dose TSEBT may also provide high rates of disease control. MATERIALS AND METHODS A retrospective chart review was conducted for patients receiving TSEBT for mycosis fungoides at a single institution from 2009 to 2017. Patients were evaluated for overall survival, progression-free survival, and duration of clinical benefit. Partial response was defined as any documented clinical regression of lesions, whereas complete response was defined as complete resolution of lesions. RESULTS Twenty patients were included in the study. Twelve patients received low-dose radiation (≤ 12 Gy), and 8 received standard-dose radiation (> 12 Gy). Response rate was 100% in both groups. The rate of complete response was 38% in the standard-dose group and 25% in the low-dose group. There was no difference in overall survival between the 2 groups (P = .84). There was also no difference in median progression-free survival (P = .95) or duration of clinical benefit (P = .95) between the 2 groups. Of low-dose patients, 33% received immediate systemic therapy, whereas 92% received adjuvant topical or systemic therapy. In the standard-dose group, only 25% received systemic adjuvant therapy, and 63% received adjuvant topical or systemic therapy. CONCLUSION Low-dose TSEBT with adjuvant therapy results in adequate symptom palliation, comparable to standard-dose TSEBT. Low-dose TSEBT should be considered a standard treatment option in this population.
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Affiliation(s)
- Charlotte I Rivers
- University at Buffalo, Buffalo, NY; Roswell Park Comprehensive Cancer Center, Buffalo, NY
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23
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Extensive Cutaneous T-Cell Lymphoma of the Feet Treated with High-Dose-Rate Brachytherapy and External Beam Radiation. Case Rep Dermatol Med 2018; 2018:5610925. [PMID: 30174962 PMCID: PMC6106951 DOI: 10.1155/2018/5610925] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2018] [Accepted: 07/17/2018] [Indexed: 11/25/2022] Open
Abstract
Cutaneous T-cell lymphoma (CTCL) is a chronic, debilitating disease that has a severe impact on quality of life. We present a patient with multiple CTCL lesions on the bilateral feet, which impaired his ability to ambulate. His lesions on both feet were successfully treated with a total of 8 Gy in two fractions via high-dose-rate surface brachytherapy using the Freiburg Flap applicator. The deeper aspects of the bulkier lesions on the left foot were boosted with electron beam therapy. The radiation therapy was well tolerated, and the patient was able to regain his mobility after completing radiation therapy. To our knowledge, there are few reports utilizing brachytherapy in treating CTCL. Our case describes treatment of larger, more extensive CTCL lesions than previously reported.
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24
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Diamantopoulos S, Kagkiouzis I, Patatoukas G, Kypraiou E, Kouloulias V, Efstathopoulos E, Platoni K. Three dimensional printed electron beam modifier for total skin electron treatments. Med Dosim 2018; 44:173-178. [PMID: 31079619 DOI: 10.1016/j.meddos.2018.05.002] [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] [Received: 01/21/2018] [Revised: 05/06/2018] [Accepted: 05/18/2018] [Indexed: 11/30/2022]
Abstract
Total Skin Electron Beam (TSEB) treatment, despite its proven effectiveness in skin malignancies, is a rather exhausting irradiation method, especially for feeble patients. In an effort to reduce treatment time by creating a clinically acceptable single TSEB field, various beam modifiers of different materials and shapes were tested. Using the TSEB immobilization device of our department and 3D printing technology, aluminum and thermoplastic modifiers were designed and constructed, according to the resulting profiles at treatment distance. Electron beam characteristics were measured and calculated both at SSD = 100 cm and at treatment level. Aluminum scatterers of the same thickness caused different modification according to the area of blocking. Aluminum modifiers reduced significantly central dose deposition for the same amount of MUs and therefore they expanded treatment time in undesirable levels. Plastic modifiers offer a good combination of field dimensions and treatment time. The final 3D printed modifier shaped the electron beam as desired resulting to a clinically acceptable 6 MeV field of 176 × 70 cm field with 10% inhomogeneity in vertical and 3% in the lateral dimension with adequate skin coverage at SSD = 400 cm. This modification offered approximately a two-minute treatment time reduction compared to the current technique. Underdosed areas appear near the edge of the field, but in regions that are far from the torso of the patient. Bremsstrahlung radiation was kept at clinically accepted levels (< 5%). This modification of the original six dual-field technique of our hospital could probably benefit fragile patients who could not easily tolerate a twenty-minute standing position without compromising the quality of their treatment.
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Affiliation(s)
- S Diamantopoulos
- 2nd Department of Radiology, Radiotherapy Unit, University General Hospital "Attikon", National and Kapodistrian University of Athens, Greece, 1 Rimini str., 12462 Chaidari, Greece.
| | - I Kagkiouzis
- 2nd Department of Radiology, Radiotherapy Unit, University General Hospital "Attikon", National and Kapodistrian University of Athens, Greece, 1 Rimini str., 12462 Chaidari, Greece
| | - G Patatoukas
- 2nd Department of Radiology, Radiotherapy Unit, University General Hospital "Attikon", National and Kapodistrian University of Athens, Greece, 1 Rimini str., 12462 Chaidari, Greece
| | - E Kypraiou
- 2nd Department of Radiology, Radiotherapy Unit, University General Hospital "Attikon", National and Kapodistrian University of Athens, Greece, 1 Rimini str., 12462 Chaidari, Greece
| | - V Kouloulias
- 2nd Department of Radiology, Radiotherapy Unit, University General Hospital "Attikon", National and Kapodistrian University of Athens, Greece, 1 Rimini str., 12462 Chaidari, Greece
| | - E Efstathopoulos
- 2nd Department of Radiology, Radiotherapy Unit, University General Hospital "Attikon", National and Kapodistrian University of Athens, Greece, 1 Rimini str., 12462 Chaidari, Greece
| | - K Platoni
- 2nd Department of Radiology, Radiotherapy Unit, University General Hospital "Attikon", National and Kapodistrian University of Athens, Greece, 1 Rimini str., 12462 Chaidari, Greece
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Elsayad K, Moustakis C, Simonsen M, Bäcker D, Haverkamp U, Eich HT. In-vivo dosimetric analysis in total skin electron beam therapy. PHYSICS & IMAGING IN RADIATION ONCOLOGY 2018; 6:61-65. [PMID: 33458390 PMCID: PMC7807580 DOI: 10.1016/j.phro.2018.05.002] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/12/2017] [Revised: 05/06/2018] [Accepted: 05/07/2018] [Indexed: 11/29/2022]
Abstract
Background and purpose Thermoluminescent dosimetry (TLD) is an important element of total skin electron beam therapy (TSEBT). In this study, we compare radiation dose distributions to provide data for dose variation across anatomic sites. Materials and methods Retrospectively collected data on 85 patients with cutaneous lymphoma or leukemia underwent TSEBT were reviewed. Patients were irradiated on two linear accelerators, in one of two positions (standing, n = 77; reclined, n = 8) and 1830 in vivo TLD measurements were obtained for various locations on 76 patients. Results The TLD results showed that the two TSEBT techniques were dosimetrically heterogeneous. At several sites, the dose administered correlated with height, weight, and gender. After the first TLD measurement, fourteen patients (18%) required MU modification, with a mean 10% reduction (range, −25 to +35). Individual TLD results allowed us to customize the boost treatment for each patient. For patients who were evaluated in the standing position, the most common underdosed sites were the axilla, perineum/perianal folds, and soles (each receiving 69%, 20%, and 34% of the prescribed dose, respectively). For patients evaluated in a reclining position, surface dose distribution was more heterogeneous. The sites underdosed most commonly were the axilla and perineum/perianal folds (receiving less than one third of prescribed dose). Significant variables were detected with model building. Conclusion TLD measurements were integral to quality assurance for TSEBT. Dose distribution at several anatomical sites correlated significantly with gender, height, and weight of the treated individual and might be predicted.
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Affiliation(s)
- Khaled Elsayad
- Department of Radiation Oncology, University Hospital of Münster, Münster, Germany
| | - Christos Moustakis
- Department of Radiation Oncology, University Hospital of Münster, Münster, Germany
| | - Manuela Simonsen
- Department of Radiation Oncology, University Hospital of Münster, Münster, Germany
| | - Dagmar Bäcker
- Department of Radiation Oncology, University Hospital of Münster, Münster, Germany
| | - Uwe Haverkamp
- Department of Radiation Oncology, University Hospital of Münster, Münster, Germany
| | - Hans Theodor Eich
- Department of Radiation Oncology, University Hospital of Münster, Münster, Germany
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Schaff EM, Rosenberg SA, Olson SJ, Howard SP, Bradley KA. Bone marrow suppression as a complication of total skin helical tomotherapy in the treatment of mycosis fungoides. Radiat Oncol 2018; 13:67. [PMID: 29653544 PMCID: PMC5899362 DOI: 10.1186/s13014-018-1013-2] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2017] [Accepted: 04/02/2018] [Indexed: 11/10/2022] Open
Abstract
Background Total skin electron beam therapy (TSEBT) is an effective treatment in mycosis fungoides. Total skin helical tomotherapy (TSHT) may be an alternative to TSEBT and may offer several dosimetric and treatment advantages. There are currently very few published treatment results using TSHT in place of TSEBT for treatment of mycosis fungoides. Case presentation Two patients with mycosis fungoides were treated at our institution using TSHT. The first patient was a 69-year-old Caucasian female with stage IVA2 (T2 N3 M0 B2) disease who was treated to a dose of 12 Gy in 8 fractions, with a bone marrow mean dose of 1.66 Gy and V10 = 0.41%. Two weeks after ending treatment the patient developed myelosuppression including grade 4 thrombocytopenia and required blood and platelet transfusions. The second patient was a 29-year-old Caucasian female with stage I (T2 N0 M0 B0) disease. This patient previously had been treated for mycosis fungoides using helical tomotherapy (HT) at a dose of 20 Gy to a localized region and experienced mild thrombocytopenia at that time. The patient then underwent retreatment 17 months later with TSHT to a dose of 12 Gy in 6 fractions with a mean bone marrow dose of 2.3 Gy and V10 = 4.28%. This patient once again experienced myelosuppression that included grade 4 thrombocytopenia. She also required blood and platelet transfusions. Conclusions Both patients treated with TSHT experienced severe bone marrow suppression including grade 4 thrombocytopenia. This was more severe than expected considering the relatively low overall prescription dose and despite a planning constraint placed on the bone marrow of a mean dose of < 2 Gy. These outcomes suggest that patients treated using TSHT should be closely monitored for myelosuppression and caution used even when treating to a dose of 12 Gy.
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Affiliation(s)
- Eric M Schaff
- Michigan State University College of Human Medicine, 418 W. Magnetic Street, Marquette, MI, 49855, USA
| | | | - Stephanie J Olson
- Department of Human Oncology, University of Wisconsin, Madison, WI, USA
| | - Steven P Howard
- Department of Human Oncology, University of Wisconsin, Madison, WI, USA
| | - Kristin A Bradley
- Department of Human Oncology, University of Wisconsin, Madison, WI, USA.
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García-Martínez E, Smith M, Buqué A, Aranda F, de la Peña FA, Ivars A, Cánovas MS, Conesa MAV, Fucikova J, Spisek R, Zitvogel L, Kroemer G, Galluzzi L. Trial Watch: Immunostimulation with recombinant cytokines for cancer therapy. Oncoimmunology 2018; 7:e1433982. [PMID: 29872569 PMCID: PMC5980390 DOI: 10.1080/2162402x.2018.1433982] [Citation(s) in RCA: 31] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2018] [Accepted: 01/24/2018] [Indexed: 12/15/2022] Open
Abstract
Cytokines regulate virtually aspects of innate and adaptive immunity, including the initiation, execution and extinction of tumor-targeting immune responses. Over the past three decades, the possibility of using recombinant cytokines as a means to elicit or boost clinically relevant anticancer immune responses has attracted considerable attention. However, only three cytokines have been approved so far by the US Food and Drug Administration and the European Medicines Agency for use in cancer patients, namely, recombinant interleukin (IL)-2 and two variants of recombinant interferon alpha 2 (IFN-α2a and IFN-α2b). Moreover, the use of these cytokines in the clinics is steadily decreasing, mostly as a consequence of: (1) the elevated pleiotropism of IL-2, IFN-α2a and IFN-α2b, resulting in multiple unwarranted effects; and (2) the development of highly effective immunostimulatory therapeutics, such as immune checkpoint blockers. Despite this and other obstacles, research in the field continues as alternative cytokines with restricted effects on specific cell populations are being evaluated. Here, we summarize research preclinical and clinical developments on the use of recombinant cytokines for immunostimulation in cancer patients.
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Affiliation(s)
- Elena García-Martínez
- Hematology and Oncology Department, Hospital Universitario Morales Meseguer, Murcia, Spain
| | - Melody Smith
- Department of Medicine and Immunology Program, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Aitziber Buqué
- Department of Radiation Oncology, Weill Cornell Medical College, New York, NY, USA
| | - Fernando Aranda
- Immunoreceptors of the Innate and Adaptive System, IDIBAPS, Barcelona, Spain
| | | | - Alejandra Ivars
- Hematology and Oncology Department, Hospital Universitario Morales Meseguer, Murcia, Spain
| | - Manuel Sanchez Cánovas
- Hematology and Oncology Department, Hospital Universitario Morales Meseguer, Murcia, Spain
| | | | - Jitka Fucikova
- Sotio, Prague, Czech Republic
- Dept. of Immunology, 2nd Faculty of Medicine and University Hospital Motol, Charles University, Prague, Czech Republic
| | - Radek Spisek
- Sotio, Prague, Czech Republic
- Dept. of Immunology, 2nd Faculty of Medicine and University Hospital Motol, Charles University, Prague, Czech Republic
| | - Laurence Zitvogel
- Gustave Roussy Comprehensive Cancer Institute, Villejuif, France
- INSERM, U1015, Villejuif, France
- Center of Clinical Investigations in Biotherapies of Cancer (CICBT) 1428, Villejuif, France
- Université Paris Sud/Paris XI, Le Kremlin-Bicêtre, France
| | - Guido Kroemer
- Université Paris Descartes/Paris V, France
- Université Pierre et Marie Curie/Paris VI, Paris
- Equipe 11 labellisée Ligue contre le Cancer, Centre de Recherche des Cordeliers, Paris, France
- INSERM, U1138, Paris, France
- Metabolomics and Cell Biology Platforms, Gustave Roussy Comprehensive Cancer Institute, Villejuif, France
- Karolinska Institute, Department of Women's and Children's Health, Karolinska University Hospital, Stockholm, Sweden
- Pôle de Biologie, Hopitâl Européen George Pompidou, AP-HP, Paris, France
| | - Lorenzo Galluzzi
- Department of Radiation Oncology, Weill Cornell Medical College, New York, NY, USA
- Université Paris Descartes/Paris V, France
- Sandra and Edward Meyer Cancer Center, New York, NY, USA
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Schüttrumpf L, Neumaier K, Maihoefer C, Niyazi M, Ganswindt U, Li M, Lang P, Reiner M, Belka C, Corradini S. Dose optimization of total or partial skin electron irradiation by thermoluminescent dosimetry. Strahlenther Onkol 2018; 194:444-453. [PMID: 29350236 DOI: 10.1007/s00066-018-1263-9] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2017] [Accepted: 01/05/2018] [Indexed: 11/26/2022]
Abstract
BACKGROUND Due to the complex surface of the human body, total or partial skin irradiation using large electron fields is challenging. The aim of the present study was to quantify the magnitude of dose optimization required after the application of standard fields. METHODS Total skin electron irradiation (TSEI) was applied using the Stanford technique with six dual-fields. Patients presenting with localized lesions were treated with partial skin electron irradiation (PSEI) using large electron fields, which were individually adapted. In order to verify and validate the dose distribution, in vivo dosimetry with thermoluminescent dosimeters (TLD) was performed during the first treatment fraction to detect potential dose heterogeneity and to allow for an individual dose optimization with adjustment of the monitor units (MU). RESULTS Between 1984 and 2017, a total of 58 patients were treated: 31 patients received TSEI using 12 treatment fields, while 27 patients underwent PSEI and were treated with 4-8 treatment fields. After evaluation of the dosimetric results, an individual dose optimization was necessary in 21 patients. Of these, 7 patients received TSEI (7/31). Monitor units (MU) needed to be corrected by a mean value of 117 MU (±105, range 18-290) uniformly for all 12 treatment fields, corresponding to a mean relative change of 12% of the prescribed MU. In comparison, the other 14 patients received PSEI (14/27) and the mean adjustment of monitor units was 282 MU (±144, range 59-500) to single or multiple fields, corresponding to a mean relative change of 22% of the prescribed MU. A second dose optimization to obtain a satisfying dose at the prescription point was need in 5 patients. CONCLUSIONS Thermoluminescent dosimetry allows an individual dose optimization in TSEI and PSEI to enable a reliable adjustment of the MUs to obtain the prescription dose. Especially in PSEI in vivo dosimetry is of fundamental importance.
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Affiliation(s)
- Lars Schüttrumpf
- Department of Radiation Oncology, University Hospital, LMU Munich, Marchioninistraße 15, 81377, Munich, Germany
| | - Klement Neumaier
- Department of Radiation Oncology, University Hospital, LMU Munich, Marchioninistraße 15, 81377, Munich, Germany
| | - Cornelius Maihoefer
- Department of Radiation Oncology, University Hospital, LMU Munich, Marchioninistraße 15, 81377, Munich, Germany
| | - Maximilian Niyazi
- Department of Radiation Oncology, University Hospital, LMU Munich, Marchioninistraße 15, 81377, Munich, Germany
| | - Ute Ganswindt
- Department of Radiation Oncology, University Hospital, LMU Munich, Marchioninistraße 15, 81377, Munich, Germany
| | - Minglun Li
- Department of Radiation Oncology, University Hospital, LMU Munich, Marchioninistraße 15, 81377, Munich, Germany
| | - Peter Lang
- Department of Radiation Oncology, University Hospital, LMU Munich, Marchioninistraße 15, 81377, Munich, Germany
| | - Michael Reiner
- Department of Radiation Oncology, University Hospital, LMU Munich, Marchioninistraße 15, 81377, Munich, Germany
| | - Claus Belka
- Department of Radiation Oncology, University Hospital, LMU Munich, Marchioninistraße 15, 81377, Munich, Germany
| | - Stefanie Corradini
- Department of Radiation Oncology, University Hospital, LMU Munich, Marchioninistraße 15, 81377, Munich, Germany.
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Low-dose total skin electron beam therapy for cutaneous lymphoma : Minimal risk of acute toxicities. Strahlenther Onkol 2017; 193:1024-1030. [PMID: 28785772 DOI: 10.1007/s00066-017-1188-8] [Citation(s) in RCA: 31] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2017] [Accepted: 07/14/2017] [Indexed: 02/03/2023]
Abstract
BACKGROUND Low-dose total skin electron beam therapy (TSEBT) is attracting increased interest for the effective palliative treatment of primary cutaneous T‑cell lymphoma (pCTCL). In this study, we compared toxicity profiles following various radiation doses. PATIENTS AND METHODS We reviewed the records of 60 patients who underwent TSEBT for pCTCL between 2000 and 2016 at the University Hospital of Munster. The treatment characteristics of the radiotherapy (RT) regimens and adverse events (AEs) were then analyzed and compared. RESULTS In total, 67 courses of TSEBT were administered to 60 patients. Of these patients, 34 (51%) received a standard dose with a median surface dose of 30 Gy and 33 patients (49%) received a low dose with the median surface dose of 12 Gy (7 salvage low-dose TSEBT courses were administered to 5 patients). After a median follow-up of 15 months, the overall AE rate was 100%, including 38 patients (57%) with grade 2 and 7 (10%) with grade 3 AEs. Patients treated with low-dose TSEBT had significantly fewer grade 2 AEs than those with conventional dose regimens (33 vs. 79%, P < 0.001). A lower grade 3 AE rate was also observed in patients who had received the low-dose regimen compared to those with the conventional dose regimens (6 vs. 15%, P = 0.78). Multiple/salvage low-dose TSEBT courses were not associated with an increased risk of acute AEs. CONCLUSION Low-dose TSEBT regimens are associated with significantly fewer grade 2 acute toxicities compared with conventional doses of TSEBT. Repeated/Salvage low-dose TSEBT, however, appears to be tolerable and can even be applied safely in patients with cutaneous relapses.
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Radiation Therapy in Peripheral T-Cell and Cutaneous Lymphomas. Radiat Oncol 2017. [DOI: 10.1007/978-3-319-52619-5_30-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
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