Helical Skin Radiation Therapy Including Total Skin Radiation Therapy Using Tomotherapy for Primary Cutaneous Lymphoma With Bone Marrow Suppression as a Related Adverse Event
Helical Skin Radiation Therapy Including Total Skin Radiation Therapy Using Tomotherapy for Primary Cutaneous Lymphoma With Bone Marrow Suppression as a Related Adverse Event
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DOI：
10.1016/j.prro.2020.11.007
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发表时间：
2021-04-30
影响因子：
3.3
通讯作者：
Nakagawa, Keiichi
中科院分区：
文献类型：
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作者：
Kitaguchi, Mayuka;Yamashita, Hideomi;Nakagawa, Keiichi
目的：全皮肤电子束治疗（TSEBT）是治疗原发性皮肤淋巴瘤的有效方法。然而，螺旋皮肤放射治疗（HSRT）使用tomotherapy可能会避免TSEBT.Methods和材料的复杂性和不确定性：2015年6月至2019年7月期间在我院接受HSRT的所有原发性皮肤淋巴瘤患者进行了调查，包括7例注册的临床试验批准的机构审查委员会（ID UMIN 000022142）。HSRT进行了3分区皮肤区域：头和颈部，躯干和手臂，和legs.Results：共24例患者53个皮肤区域（包括8例患者24个皮肤区域进行了连续的全皮肤照射），中位随访时间为13个月（范围，2-50），进行了调查。蕈样肉芽肿20例（83.3%）。53例中41例（77.4%）采用20戈伊分10次照射。MF患者每种HSRT治疗野的总有效率为100%，其中完全缓解38例（80.9%），部分缓解4例（8.5%），部分缓解5例（10.6%）。8例MF患者接受连续全皮肤照射显示100%完全缓解。对于MF患者，第一轮HSRT后的中位生存时间为22个月（95%置信区间[CI]，13.6-30.4个月），每个HSRT的中位缓解持续时间为5个月（95% CI，3.67-6.32个月），每个HSRT的中位至现场再照射时间为15个月（95% CI，9.76-20.24个月）。骨髓抑制（>3级）多发生在躯干和臂部皮肤（94.1%）。早期患者死于HSRT引起的5级leukopenia.Conclusions：HSRT靶向躯干和手臂皮肤引起严重的骨髓抑制，导致暂时的姑息治疗效果。TSEBT仍应被视为覆盖全身表面积的原发性皮肤淋巴瘤的标准治疗。(C)2020年美国放射肿瘤学会。爱思唯尔公司出版All rights reserved.
Purpose: Total skin electron beam therapy (TSEBT) is useful for primary cutaneous lymphoma. However, helical skin radiation therapy (HSRT) using tomotherapy may avoid the complexity and uncertainty of TSEBT.Methods and Materials: All patients with primary cutaneous lymphoma who underwent HSRT at our hospital between June 2015 and July 2019 were investigated, including 7 patients registered in a clinical trial approved by an institutional review board (ID UMIN000022142). HSRT was performed in 3 partitioned skin areas: head and neck, trunk and arms, and legs.Results: A total of 24 patients with 53 skin areas (including 8 patients with 24 skin areas who had undergone sequential total skin irradiation), with a median follow-up time of 13 months (range, 2-50), were investigated. Twenty patients (83.3%) had mycosis fungoides (MF). For 41 of 53 (77.4%) cases, a dose of 20 Gy in 10 fractions was used. The overall response rate in the treated fields of each HSRT in patients with MF was 100%, including 38 (80.9%) complete response, 4 (8.5%) good partial response, and 5 (10.6%) partial response. Eight patients with MF who underwent sequential total skin irradiation showed a 100% complete response. For patients with MF, the median survival time after a first round of HSRT was 22 months (95% confidence interval [CI], 13.6-30.4 months), the median response duration of each HSRT was 5 months (95% CI, 3.67-6.32 months), and the median time to in-field reirradiation for each HSRT was 15 months (95% CI, 9.76-20.24 months). Bone marrow suppression (grade >3) often occurred (94.1%) with HSRT on trunk and arm skin. An early patient died of HSRT-caused grade 5 leukopenia.Conclusions: HSRT targeting trunk and arm skin induced severe bone marrow suppression that led to a temporary palliative effect. TSEBT should still be considered standard treatment for primary cutaneous lymphoma covering the total body surface area. (C) 2020 American Society for Radiation Oncology. Published by Elsevier Inc. All rights reserved.