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Helical irradiation of the total skin with dose painting to replace total skin electron beam therapy for therapy-refractory cutaneous CD4+ T-cell lymphoma.

Hsieh CH, Shueng PW, Lin SC, Tien HJ, Shiau AC, Chou YH, Wu MH, Wang JY, Chen CK, Chen YJ - Biomed Res Int (2013)

Bottom Line: The diving suit was dressed whole body to increase the superficial dose and using central core complete block (CCCB) technique for reducing the internal organ dose.The dosage of left side pretreated area was decreased 57%.HITS with dose painting techniques provides precise dosage delivery with impressive results, sparing critical organs, and offering limited transient and chronic sequelae for previously locally irradiated, therapy-refractory cutaneous T-cell lymphoma.

View Article: PubMed Central - PubMed

Affiliation: Division of Radiation Oncology, Department of Radiology, Far Eastern Memorial Hospital, No. 21, Section 2, Nanya S. Road, Banciao District, New Taipei City 220, Taiwan ; Department of Medicine, School of Medicine, National Yang-Ming University, Taipei 112, Taiwan ; Institute of Traditional Medicine, School of Medicine, National Yang-Ming University, Taipei 112, Taiwan.

ABSTRACT
A 36-year-old woman was diagnosed with a therapy-refractory cutaneous CD4+ T-cell lymphoma, T3N0M0B0, and stage IIB. Helical irradiation of the total skin (HITS) and dose painting techniques, with 30 Gy in 40 fractions interrupted at 20 fractions with one week resting, 4 times per week were prescribed. The diving suit was dressed whole body to increase the superficial dose and using central core complete block (CCCB) technique for reducing the internal organ dose. The mean doses of critical organs of head, chest, and abdomen were 2.1 to 29.9 Gy, 2.9 to 8.1 Gy, and 3.6 to 15.7 Gy, respectively. The mean dose of lesions was 84.0 cGy. The dosage of left side pretreated area was decreased 57%. The tumor regressed progressively without further noduloplaques. During the HITS procedure, most toxicity was grade I except leukocytopenia with grade 3. No epitheliolysis, phlyctenules, tumor lysis syndrome, fever, vomiting, dyspnea, edema of the extremities, or diarrhea occurred during the treatment. HITS with dose painting techniques provides precise dosage delivery with impressive results, sparing critical organs, and offering limited transient and chronic sequelae for previously locally irradiated, therapy-refractory cutaneous T-cell lymphoma.

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Laboratory results. No abnormal liver, renal, thyroid functions, or gonadotropin hormone were noted. Grade I anemia, thrombocytopenia, and grade 3 leukocytopenia were noted during the HITS procedure. Two months later, she developed grade 4 pancytopenia but recovered to grade 3 leukocytopenia and thrombocytopenia in the 3rd month after the treatment was completed.
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fig5: Laboratory results. No abnormal liver, renal, thyroid functions, or gonadotropin hormone were noted. Grade I anemia, thrombocytopenia, and grade 3 leukocytopenia were noted during the HITS procedure. Two months later, she developed grade 4 pancytopenia but recovered to grade 3 leukocytopenia and thrombocytopenia in the 3rd month after the treatment was completed.

Mentions: Patient data was collected with the approval of the Institutional Review Board of our Hospital. Thirty gray were delivered to the patient from March 19, 2012 to June 29, 2012. The tumor regressed progressively over the entire body without further noduloplaques (Figures 4(a), 4(b), and 4(d)). After HITS, the following pathologic report showed only inflammation change without tumors persist (Figures 1(h) and 1(i)). Grade I dermatitis, mucositis, xerostomia, fatigue, and body weight loss (51 to 46 kg) were noted during the HITS and onycholysis during the two months following completion of the treatment (Figure 4(c)). Additionally, grade I anemia, thrombocytopenia, and grade 3 leukocytopenia were also noted during the HITS procedure (Figure 5). No epitheliolysis, phlyctenules, tumor lysis syndrome, fever, vomiting, dyspnea, edema of the extremities, or diarrhea occurred during the treatment. No abnormal liver, renal, thyroid functions, or gonadotropin hormone were noted during or after treatment (Figure 5). Transient alopecia was noted during HITS but she recovered without permanent partial alopecia 3 months later. Skin itching off and on over the trunk persisted from the beginning until the final report. Two months later, she developed grade 4 pancytopenia but recovered to grade 3 leukocytopenia and thrombocytopenia in the 3rd months after the treatment was completed. Supportive measures were provided including hematopoietic colony-stimulating factors (CSF), steroids, antioxidants, oral glutamine, and yeast-derived 1,3/1,6 glucopolysaccharide. From the treatment until now, a complete response was noted, with the white cell count recovering to grade 2, and the hemoglobulin and platelet counts recovering to grade 1 (Figure 5).


Helical irradiation of the total skin with dose painting to replace total skin electron beam therapy for therapy-refractory cutaneous CD4+ T-cell lymphoma.

Hsieh CH, Shueng PW, Lin SC, Tien HJ, Shiau AC, Chou YH, Wu MH, Wang JY, Chen CK, Chen YJ - Biomed Res Int (2013)

Laboratory results. No abnormal liver, renal, thyroid functions, or gonadotropin hormone were noted. Grade I anemia, thrombocytopenia, and grade 3 leukocytopenia were noted during the HITS procedure. Two months later, she developed grade 4 pancytopenia but recovered to grade 3 leukocytopenia and thrombocytopenia in the 3rd month after the treatment was completed.
© Copyright Policy - open-access
Related In: Results  -  Collection

Show All Figures
getmorefigures.php?uid=PMC3794623&req=5

fig5: Laboratory results. No abnormal liver, renal, thyroid functions, or gonadotropin hormone were noted. Grade I anemia, thrombocytopenia, and grade 3 leukocytopenia were noted during the HITS procedure. Two months later, she developed grade 4 pancytopenia but recovered to grade 3 leukocytopenia and thrombocytopenia in the 3rd month after the treatment was completed.
Mentions: Patient data was collected with the approval of the Institutional Review Board of our Hospital. Thirty gray were delivered to the patient from March 19, 2012 to June 29, 2012. The tumor regressed progressively over the entire body without further noduloplaques (Figures 4(a), 4(b), and 4(d)). After HITS, the following pathologic report showed only inflammation change without tumors persist (Figures 1(h) and 1(i)). Grade I dermatitis, mucositis, xerostomia, fatigue, and body weight loss (51 to 46 kg) were noted during the HITS and onycholysis during the two months following completion of the treatment (Figure 4(c)). Additionally, grade I anemia, thrombocytopenia, and grade 3 leukocytopenia were also noted during the HITS procedure (Figure 5). No epitheliolysis, phlyctenules, tumor lysis syndrome, fever, vomiting, dyspnea, edema of the extremities, or diarrhea occurred during the treatment. No abnormal liver, renal, thyroid functions, or gonadotropin hormone were noted during or after treatment (Figure 5). Transient alopecia was noted during HITS but she recovered without permanent partial alopecia 3 months later. Skin itching off and on over the trunk persisted from the beginning until the final report. Two months later, she developed grade 4 pancytopenia but recovered to grade 3 leukocytopenia and thrombocytopenia in the 3rd months after the treatment was completed. Supportive measures were provided including hematopoietic colony-stimulating factors (CSF), steroids, antioxidants, oral glutamine, and yeast-derived 1,3/1,6 glucopolysaccharide. From the treatment until now, a complete response was noted, with the white cell count recovering to grade 2, and the hemoglobulin and platelet counts recovering to grade 1 (Figure 5).

Bottom Line: The diving suit was dressed whole body to increase the superficial dose and using central core complete block (CCCB) technique for reducing the internal organ dose.The dosage of left side pretreated area was decreased 57%.HITS with dose painting techniques provides precise dosage delivery with impressive results, sparing critical organs, and offering limited transient and chronic sequelae for previously locally irradiated, therapy-refractory cutaneous T-cell lymphoma.

View Article: PubMed Central - PubMed

Affiliation: Division of Radiation Oncology, Department of Radiology, Far Eastern Memorial Hospital, No. 21, Section 2, Nanya S. Road, Banciao District, New Taipei City 220, Taiwan ; Department of Medicine, School of Medicine, National Yang-Ming University, Taipei 112, Taiwan ; Institute of Traditional Medicine, School of Medicine, National Yang-Ming University, Taipei 112, Taiwan.

ABSTRACT
A 36-year-old woman was diagnosed with a therapy-refractory cutaneous CD4+ T-cell lymphoma, T3N0M0B0, and stage IIB. Helical irradiation of the total skin (HITS) and dose painting techniques, with 30 Gy in 40 fractions interrupted at 20 fractions with one week resting, 4 times per week were prescribed. The diving suit was dressed whole body to increase the superficial dose and using central core complete block (CCCB) technique for reducing the internal organ dose. The mean doses of critical organs of head, chest, and abdomen were 2.1 to 29.9 Gy, 2.9 to 8.1 Gy, and 3.6 to 15.7 Gy, respectively. The mean dose of lesions was 84.0 cGy. The dosage of left side pretreated area was decreased 57%. The tumor regressed progressively without further noduloplaques. During the HITS procedure, most toxicity was grade I except leukocytopenia with grade 3. No epitheliolysis, phlyctenules, tumor lysis syndrome, fever, vomiting, dyspnea, edema of the extremities, or diarrhea occurred during the treatment. HITS with dose painting techniques provides precise dosage delivery with impressive results, sparing critical organs, and offering limited transient and chronic sequelae for previously locally irradiated, therapy-refractory cutaneous T-cell lymphoma.

Show MeSH
Related in: MedlinePlus