Radiotherapy is one of the standard treatments for cutaneous lymphoma and Total Skin Electrons Beam Irradiation (TSEBI) is generally used to treat diffuse cutaneous lymphoma and some cases of localized disease. Helical IMRT (HI) allows to treat complex target with optimal dose distribution and organ at risk sparing, so helical tomotherapy has been proposed as alternative technique to TSEBI but only one preliminary report has been published.
Three patients treated (from May 2013 to December 2014) with Helical IMRT, with a total dose between 24 and 30 Gy, were retrospectively evaluated. Data about dosimetric features, response and acute toxicity were registered and analyzed.
Planned target coverage was compared with daily in vivo measures and dose calculation based on volumetric images used for set up evaluation as well.
The patients had a mean measured surface fraction dose ranging from 1.54 Gy up to 2.0 Gy. A planned target dose ranging from 85 to 120% of prescription doses was obtained. All doses to Organs At Risk were within the required constraints. Particular attention was posed on “whole bone marrow” planned V10Gy, V12Gy and V20Gy values, ranging respectively between 23 and 43%, 20.1 and 38% and 9.8 and 24%. A comparison with the theoretical homologous values obtained with TSEBI has shown much lower values with TSEBI.
Even if treatment was given in sequence to the skin of the upper and lower hemi-body, all the patients had anaemia, requiring blood transfusions, leukopenia and thrombocytopenia.
Based on our limited results TSEBI should still be considered the standard method to treat total skin because of its pattern of acute and late toxicities and the dose distribution. In this particular case the better target coverage obtained with HI can be paid in terms of worse toxicity. Helical IMRT can instead be considered optimal in treating large, convex, cutaneous areas where it is difficult to use multiple electrons fields in relation with the clinical results and the limited and reversible toxicities.
Olsen E, Vonderheid E, Pimpinelli N, et al. Revisions to the staging and classification of mycosis fungoides and Sezary syndrome: a proposal of the International Society for Cutaneous Lymphomas (ISCL) and the cutaneous lymphoma task force of the European Organization of Research and Treatment of Cancer (EORTC). Blood. 2007;110:1713–22. CrossRefPubMed
Elsayad K, Kriz J, Moustakis C, Scobioala S, Reinartz G, Haverkamp U, Willich N, Weishaupt C, Stadler R, Sunderkötter C, Eich HT. Total skin Electron beam for primary cutaneous T-cell Lymphoma. Int J Radiat Oncol Biol Phys. 2015;93(5):1077–86. https://doi.org/10.1016/j.ijrobp.2015.08.041. CrossRefPubMed
Pedretti S, Urpis M, Leali C, Borghetti P, Baushi L, Sala R, Tucci A, Greco D, Pasinetti N, Triggiani L, Rossi G, Calzavara-Pinton P, Magrini SM, Buglione M. Primary cutaneous non-Hodgkin lymphoma: results of a retrospective analysis in the light of the recent ILROG guidelines. Tumori. 2017; https://doi.org/10.5301/tj.5000606.
Goujon E, Truc G, Pétrella T, Maingon P, Jeudy G, Collet E, Galliot C, Dalac-Rat S. Total skin electron beam for early-stage mycosis fungoides: immediate results and long term follow-up in 68 patients. Ann Dermatol Venereol. 2009;136(3):249–55. https://doi.org/10.1016/j.annder.2008.11.017. CrossRefPubMed
Gettler SL. Fung MA efficacy of treatments for mycosis fungoides and Sezary syndrome: nationwide survey responses. Dermatol Online J. 2005;11(3):6. PubMed
Karzmack C. 1987. Total skin electron therapy: technique and dosimetry. Report no. 23.
Piotrowski T, Malicki J. The rotary dual technique for total skin irradiation in the treatment of mycosis fungoides - a description of applied method. Rep Pract Oncol Radiother. 2006;11:29–37. CrossRef
Mazzeo E, Rubino L, Buglione M, Antognoni P, Magrini SM, Bertoni F, Parmiggiani M, Barbieri P, Bertoni F. The current management of mycosis Fungoides and Sèzary syndrome and the role of radiotherapy: principles and indications. Rep Pract Oncol Radiother. 2013;19(2):77–91. Review CrossRefPubMedPubMedCentral
Hsieh CH, Shueng PW, Lin SC, Tien HJ, Shiau AC, Chou YH, Wu MH, Wang JY, Chen CK, Chen YJ. Helical irradiation of the total skin whit dose painting to replace total skin electron beam therapy for therapy-refactory cutaneous CD4+ T-cell lymphoma. Biomed Res Int; 2013. https://doi.org/10.1155/2013/717589.
Niromand-rad A, Blackwell CR, Coursey BM, Gall KP, Galvin JM, MacLaughlin WL, Meigooni AS, Ravinder N, Rodgers JE, Soares CG. Radiochromic film dosimetry: recommendations of AAPM radiation therapy committee task group 55. Med Phys. 1998;25(11):2093–115. CrossRef
Jones GW, Kacinski BM, Wilson LD, et al. Total skin electron irradiation in the management of mycosis fungoides: consensus of the European organization fo the research and treatment of Cancer (EORTC) cutaneous lymphoma project group. J Am Acad Dermatolo. 2002;47:364–70. CrossRef
Takahashi Y, Stefano Vagge MD, Agostinelli S, Han E, Matulewicz L, et al. Multi-institutional Feasibility Study of a Fast Patient Localization Method in Total Marrow Irradiation With Helical Tomotherapy: A Global Health Initiative by the International Consortium of Total Marrow Irradiation. Int J Radiat Oncol Biol Phys. 2015;91(1):30–8. CrossRefPubMed
Hank B, O’Reilly R, Cunningham I, Kernan N, Yaholom J, Brochstein J, et al. Total body irradiation for bone marrow transplantation: the Memorial Sloan-Kettering Cancer Center experience. Radiother Oncol. 1990;18(Suppl 1):68–81.
- Light and shadows of a new technique: is photon total-skin irradiation using helical IMRT feasible, less complex and as toxic as the electrons one?
Stefano Maria Magrini
- BioMed Central
Neu im Fachgebiet Onkologie
Mail Icon II