Perianal Paget's disease

Radiotherapy for perianal Paget's disease

The role of radiotherapy in the management of perianal Paget's disease (PPD) is not well defined in clinical practice or within the medical literature. We present 6 cases, document the radiotherapy details and review our results. A comprehensive literature search has been undertaken attempting to identify all published cases of PPD and survey the number receiving radiotherapy. To further define the role for radiotherapy in PPD these cases have been reviewed. Published results are sporadic and often poorly documented with respect to technical radiotherapy details. Two main roles for radiotherapy in PPD were found. One is as primary treatment for in situ or invasive disease and the other is following surgical relapse of in-situ or invasive disease. Other possible uses of radiotherapy in PPD such as neoadjuvant or adjuvant treatment or chemo-radiotherapy are discussed. Results of radiotherapy treatment for case of in situ and invasive disease are presented. We disagree with the view in some areas of the surgical literature that radiotherapy has no place in the management of the disease. Despite a thorough surveying of the literature however, precise recommendations on several areas of the technical radiotherapy treatment such as dose-fractionation schedules and field margins are difficult because of the small number of cases and poor general documentation. Our practice recommendations are presented. Radiotherapists should be encouraged to publish their experience in this disease to help define further a role for this treatment.

Radiotherapy for genital extramammary Paget's disease in situ

BACKGROUND

Radiotherapy as a first-choice treatment for extramammary Paget's (EMP) disease in situ has been seldom used.

OBJECTIVE

To review the most relevant aspects of radiotherapy as first-choice treatment in selected cases of anogenital EMP disease in situ.

METHODS

Two men with an age range of 71-79 years (mean age 75 +/- 5.6 years) with EMP disease in situ localized in the genital region were treated by means of X-rays of 100 kV, 440 cGy/day, 3 days a week over 3 weeks until a total dose of 3960 cGy was completed.

RESULTS

Complete regression of EMP disease in situ was observed in both patients after radical radiation therapy and neither local recurrences nor internal malignancies have been documented.

CONCLUSION

Radiotherapy is a curative treatment in selected cases of EMP disease in situ affecting large areas of the anogenital region.