Radiotherapy of advanced mycosis fungoides: indications and results of total skin electron beam and photon beam irradiation
Radiotherapy of advanced mycosis fungoides: indications and results of total skin electron beam and photon beam irradiation
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DOI：
10.1016/s0167-8140(99)00162-0
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发表时间：
2000-01-01
影响因子：
5.7
通讯作者：
Horiot, JC
中科院分区：
文献类型：
--
作者：
Maingon, P;Truc, G;Horiot, JC
背景资料：对晚期蕈样肉芽肿进行回顾性研究的目的是（1）描述全身皮肤电子束和光子束照射联合治疗的适应症;（2）分析全身或节段光子照射对皮肤以外扩展患者的结果。方法：从1975年1月至1995年12月，45例经病理证实的蕈样肉芽肿或Sezary综合征患者接受了TSEB和光子束照射联合治疗晚期疾病：34例男性和11例女性，平均年龄61岁（范围27-87岁）。平均随访时间为111个月（范围18-244个月，中位数85个月）。用6 MeV电子束，以24-30戈伊的总剂量，分8-15次，每周3-4次，照射深度3-5 mm。（特别是在头颈部或腋窝），用Co-60光子束局部照射（RRT），然后用全皮肤电子束照射（15例）。在弥漫性红皮病、Sezary综合征、淋巴结或内脏受累的病例中，使用分程方案使用25 MV光子束进行全身照射，以防止血液学毒性（22例患者）。第一疗程为1.25戈伊，分10次照射，共10天。TSEB治疗后4 ~ 6周再行1.25戈伊的第二疗程。在约3个月内累积TBI剂量范围为2.5至3戈伊。用Co-60进行半身照射（HB）对多个区域性肿瘤伴皮肤大而厚浸润的病例，给予9-12戈伊剂量（和团注）（使用1-1.5戈伊/天的剂量），一旦变平，用全皮肤电子束治疗加强结果：3个月时，总有效率为75%，其中完全缓解23/45例（51%），部分缓解24%; T3组总有效率为81%，T4组为61%，N1组为79%，N3组为70%。T3的完全缓解率为67%，T4为28%。64%的N1患者和41%的N3患者完全缓解。T3和T4的5年精算总生存率分别为37%和44%（P = 0.84）。病理学阴性（N1）的临床异常淋巴结患者的5年生存率为63%。病理阳性的淋巴结（N3）的患者经历了32%（P = 0.040）的5年生存率。结论：TSEB提供了一个很好的生活质量，减少瘙痒和从皮肤分泌物。患有更晚期疾病的患者可以通过添加光子束与TSEB组合来治疗和治愈。一个选择的患者与先进的皮肤病和区域扩展可以治愈的TSEB和光子束照射的组合。区域治疗允许在减少斑块或厚肿瘤后使用电子，并对邻近淋巴结区域进行预防性照射。(C)2000爱思唯尔科学爱尔兰有限公司保留所有权利。
Background: The goals of this retrospective study of advanced mycosis fungoides are (1) to describe the indications of a combination of total skin electron beam and photon beam irradiation and (2) to analyze the results of total body or segmental photon irradiation for patients with extension beyond the skin.Methods: From January 1975 to December 1995, 45 patients with pathologically-confirmed mycosis fungoides or Sezary syndrome received a combination of TSEB and photon beam irradiation for advanced disease: 34 males and 11 females, mean age 61 years (range 27-87 years). The mean follow-up was 111 months (range 18-244 months, median 85 months). Whole-skin irradiation treatment to a depth of 3-5 mm with a 6-MeV electron beam was produced by a linear accelerator to a total dose of 24-30 Gy in 8-15 fractions, 3-4 times a week, In cases of thick plaques or tumors that were beyond the scope of low energy electron beams of for treating nodal areas (especially in the head and neck area or axilla involvement), regional irradiation (RRT) with Co-60 photon beams was followed by whole-skin electron beam irradiation (15 patients). In cases of diffuse erythrodermia, Sezary syndrome, nodal or visceral involvement, total body irradiation was delivered with a 25-MV photon beam using a split-course regimen to prevent hematological toxicity (22 patients). The first course consisted of 1.25 Gy delivered in ten fractions and 10 days. Subsequently, patients received TSEB, Four to 6 weeks after TSEB, they received a second course of 1.25 Gy. The cumulative TBI dose ranged from 2.5 to 3 Gy in about 3 months. Hemi-body irradiation (HB) with Co-60 (and a bolus) was given in cases of multiple regional tumors with large and thick infiltration of the skin to a dose of 9-12 Gy (using fractions of 1-1.5 Gy/day) which, once flattened, were boosted with whole-skin electron beam therapy (8 patients).Results: At 3 months, the overall response rate was 75% with 23/45 (51%) patients in complete response and 24% in partial response; one patient had stable lesions and 1 patient presented progressive disease, The overall response rate was 81% for T3 patients, 61% for T4, 79% for N1 and 70% for N3. The complete response rate was 67% for T3 and 28% for T4. Sixty-four percent of N1 patients and 41% of N3 had a complete response. The 5-year actuarial overall survival was 37% for T3 and 44% for T4 (P = 0.84). Patients with clinically abnormal lymph nodes that were pathologically negative (N1) presented a 5-year survival of 63%. Patients with pathologically positive lymph nodes (N3) experienced a 5-year survival rate of 32% (P = 0.040).Conclusions: TSEB provides an excellent quality of life by reducing itching and discharge from the skin. Patients with more advanced disease may be treated and cured by the addition of photon beams in combination with TSEB. A selection of patients with advanced skin disease and regional extension may be cured by a combination of TSEB and photon beam irradiation. The regional treatment allows the use of electrons after the reduction of the plaques or thick tumors and a prophylactic irradiation of the adjacent nodal area. (C) 2000 Elsevier Science Ireland Ltd. All rights reserved.