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Rapidly progressive stage IVB mycosis fungoides treated with low-dose total skin electron beam therapy.

Chowdhary M, Kabbani AA, Rimtepathip P, Cole DA, Cohen DJ - Onco Targets Ther (2015)

Bottom Line: Remarkably, our patient showed nearly complete (95%) response of his MF with no apparent side effects from radiation.Our case illustrates the benefit of using TSEB in stage IV MF.Additionally, our experience shows that low-dose TSEB can occasionally be efficacious in stage IV disease.

View Article: PubMed Central - PubMed

Affiliation: Division of Dermatology, Department of Internal Medicine, Mercer University School of Medicine, Macon, GA, USA ; Division of Radiation Oncology, Department of Radiology, Mercer University School of Medicine, Macon, GA, USA.

ABSTRACT
Mycosis fungoides (MF) is the most common subtype of primary cutaneous T-cell lymphoma. Normally, MF has an indolent course although patients can progress to an advanced disease state (stages IIB-IVB). Advanced-stage disease is typically aggressive, leaving patients with debilitating symptoms and a decreased quality of life. Moreover, advanced-stage MF often proves refractory to therapy and carries a very poor prognosis. Total skin electron beam (TSEB) therapy is a well-established and successful treatment for early stage MF; however, its efficacy dramatically decreases with advanced-stage disease. In fact, TSEB in advanced-stage MF is generally considered to be palliative. Current consensus guidelines recommend a dose of 30-36 Gy to be delivered in 8-10 weeks; however, limited studies exist to determine the ideal treatment in Stage IV MF. Herein, we describe a case of a 50-year-old male who developed rapidly progressive stage IVB (T3N3M1B0) MF and was treated with low-dose (24 Gy) TSEB over 8 weeks. The patient was not treated with any systemic therapy before starting TSEB due to the widespread nature and the speed of disease progression. Remarkably, our patient showed nearly complete (95%) response of his MF with no apparent side effects from radiation. Furthermore, he has remained in remission over 4 years, requiring only a small boost to a few "shadowed" areas. Our case illustrates the benefit of using TSEB in stage IV MF. Additionally, our experience shows that low-dose TSEB can occasionally be efficacious in stage IV disease.

No MeSH data available.


Related in: MedlinePlus

Disease course before and after TSEB.Notes: (A, D) Initial presentation of patient revealed only eczematous changes. (B, E) Rapid disease progression within 3 months demonstrating multiple tumorous nodules throughout the body. (C, F) Complete disease response after 3 months following TSEB. (A–C) Progression of disease course in the face. (D–F) Progression of disease course in upper extremities.Abbreviation: TSEB, total skin electron beam.
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f1-ott-8-1597: Disease course before and after TSEB.Notes: (A, D) Initial presentation of patient revealed only eczematous changes. (B, E) Rapid disease progression within 3 months demonstrating multiple tumorous nodules throughout the body. (C, F) Complete disease response after 3 months following TSEB. (A–C) Progression of disease course in the face. (D–F) Progression of disease course in upper extremities.Abbreviation: TSEB, total skin electron beam.

Mentions: A 50-year-old African-American male with no significant past medical history was referred to our clinic due to new onset diffuse, infiltrative hyperpigmented plaques covering his upper body (Figure 1A and D). The affected areas were edematous, pruritic, and oozing. Punch biopsy from these plaques suggested a benign inflammatory eczematous condition. The patient was therefore prescribed topical 0.1% triamcinolone acetonide for his acute flare.


Rapidly progressive stage IVB mycosis fungoides treated with low-dose total skin electron beam therapy.

Chowdhary M, Kabbani AA, Rimtepathip P, Cole DA, Cohen DJ - Onco Targets Ther (2015)

Disease course before and after TSEB.Notes: (A, D) Initial presentation of patient revealed only eczematous changes. (B, E) Rapid disease progression within 3 months demonstrating multiple tumorous nodules throughout the body. (C, F) Complete disease response after 3 months following TSEB. (A–C) Progression of disease course in the face. (D–F) Progression of disease course in upper extremities.Abbreviation: TSEB, total skin electron beam.
© Copyright Policy
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4493984&req=5

f1-ott-8-1597: Disease course before and after TSEB.Notes: (A, D) Initial presentation of patient revealed only eczematous changes. (B, E) Rapid disease progression within 3 months demonstrating multiple tumorous nodules throughout the body. (C, F) Complete disease response after 3 months following TSEB. (A–C) Progression of disease course in the face. (D–F) Progression of disease course in upper extremities.Abbreviation: TSEB, total skin electron beam.
Mentions: A 50-year-old African-American male with no significant past medical history was referred to our clinic due to new onset diffuse, infiltrative hyperpigmented plaques covering his upper body (Figure 1A and D). The affected areas were edematous, pruritic, and oozing. Punch biopsy from these plaques suggested a benign inflammatory eczematous condition. The patient was therefore prescribed topical 0.1% triamcinolone acetonide for his acute flare.

Bottom Line: Remarkably, our patient showed nearly complete (95%) response of his MF with no apparent side effects from radiation.Our case illustrates the benefit of using TSEB in stage IV MF.Additionally, our experience shows that low-dose TSEB can occasionally be efficacious in stage IV disease.

View Article: PubMed Central - PubMed

Affiliation: Division of Dermatology, Department of Internal Medicine, Mercer University School of Medicine, Macon, GA, USA ; Division of Radiation Oncology, Department of Radiology, Mercer University School of Medicine, Macon, GA, USA.

ABSTRACT
Mycosis fungoides (MF) is the most common subtype of primary cutaneous T-cell lymphoma. Normally, MF has an indolent course although patients can progress to an advanced disease state (stages IIB-IVB). Advanced-stage disease is typically aggressive, leaving patients with debilitating symptoms and a decreased quality of life. Moreover, advanced-stage MF often proves refractory to therapy and carries a very poor prognosis. Total skin electron beam (TSEB) therapy is a well-established and successful treatment for early stage MF; however, its efficacy dramatically decreases with advanced-stage disease. In fact, TSEB in advanced-stage MF is generally considered to be palliative. Current consensus guidelines recommend a dose of 30-36 Gy to be delivered in 8-10 weeks; however, limited studies exist to determine the ideal treatment in Stage IV MF. Herein, we describe a case of a 50-year-old male who developed rapidly progressive stage IVB (T3N3M1B0) MF and was treated with low-dose (24 Gy) TSEB over 8 weeks. The patient was not treated with any systemic therapy before starting TSEB due to the widespread nature and the speed of disease progression. Remarkably, our patient showed nearly complete (95%) response of his MF with no apparent side effects from radiation. Furthermore, he has remained in remission over 4 years, requiring only a small boost to a few "shadowed" areas. Our case illustrates the benefit of using TSEB in stage IV MF. Additionally, our experience shows that low-dose TSEB can occasionally be efficacious in stage IV disease.

No MeSH data available.


Related in: MedlinePlus