Background
Methods
Patient #1 (female) | Patient #2 (male) | Patient #3 (male) | |
---|---|---|---|
Diagnosis | MF (stage IVA1; T4N0M0) with erithrodermic disease, | Diffuse cutaneous and systemic localizations of cutaneous T cell lymphoma, | Granulomatous MF (stage II) slack skin |
Previous treatments | Chemotherapy and UVB-PUVA, but never treated with radiotherapy | Different types of cutaneous therapies (PUVA), chemotherapy and localized RT, and finally proposed for palliative total-skin irradiation | Previously untreated |
Prescribed dose (Median target dose) | 27.0Gy/1.8Gy/fr (upper body) 26.0Gy/2.0Gy/fr (lower body) (22.05Gy/1.47Gy/fr Gy for the scalp and eyelids) 23 days split in between the two | 28.8Gy/1.8Gy/fr (upper body) 28.8Gy/1.8Gy/fr (lower body) 15 days split in between the two | 30.4 Gy/1.9 Gy/fr (upper body) 30.0 Gy/2 Gy/fr (lower body) 8 days split in between the two |
Compensative electrons boost on “under-dosed” regions | One field electron boost (upper back) after the end of the photon treatment. | 4 electron field boosts (right arm, left arm, inguinal, right foot dorsum). During the split between the first and the second part of the photon treatment | 9 electron field boosts (right and left forearm, right and left arm, right back, left back, internal right thigh). During the split between the first and the second part of the photon treatment |
Response to RT and duration | Short complete remission (6 months) | Short complete remission (6 months) | Complete remission (4 years) |
Immobilization and target definition
Clinical dose prescription
Physical features of the treatment
Pat
|
Treatment session
|
Plan
|
Duration (min)
|
N. rotations
|
N. fractions
|
Number of PTV sub-volumes used in optimization
|
Number of region at risk used in optimization
|
---|---|---|---|---|---|---|---|
#1 | Upper Hemibody | #1 U1 | 22.6 | 45.3 | 3 | 56 | 33 |
#1 U2 | 22.6 | 43.7 | 12 | 56 | 25 | ||
Lower Hemibody | #1 L1 | 23.6 | 19 | 10 | 14 | 14 | |
#1 L2 | 23.6 | 19 | 3 | 14 | 14 | ||
#2 | Upper Hemibody | #2 U1 | 27.1 | 56 | 8 | 59 | 27 |
#2 U2 | 28.9 | 56 | 8 | 68 | 28 | ||
Lower Hemibody | #2 L1 | 40.0 | 50.1 | 3 | 45 | 35 | |
#2 L2 | 40.0 | 50.1 | 13 | 46 | 34 | ||
#3 | Upper Hemibody | #3 U1 | 27.2 | 52.7 | 3 | 61 | 45 |
#3 U2 | 27.2 | 52.7 | 13 | 74 | 56 | ||
Lower Hemibody | #3 L1 | 29.4 | 83.9 | 15 | 71 | 42 |
Response assessment
Toxicity evaluation
Statistical analysis
Results
Target dose
Target DVH points (Gy) | ||||
---|---|---|---|---|
Treatment session | DVH point | Patient #1 | Patient #2 | Patient #3 |
Upper hemi body: #1: 27/1.8 Gy #2: 28.8/1.8 Gy #3: 28.8/1.8 Gy | D (10 ml) | 30.8 | 34.1 | 35.7 |
D (2%) | 30.0 | 33.1 | 34.9 | |
D (50%)
|
26.4
|
28.5
|
30.9
| |
D (90%) | 22.4 | 22.2 | 23.8 | |
D (95%) | 19.4 | 19.7 | 19.8 | |
Lower hemi body: #1: 26/2 Gy #2: 28.8/1.8 Gy #3: 27.0/1.8 Gy | D(10 ml) | 29.6 | 33.6 | 35.3 |
D (2%) | 28.9 | 33.0 | 34.5 | |
D (50%)
|
25.7
|
28.5
|
30.9
| |
D (90%) | 23.1 | 19.7a | 28.5 | |
D (95%) | 21.7 | 14.2a | 27.5 |
Organs at risk dose
Organs
|
Plans total mean dose (Gy)
|
DODAs mean doses CL – 3σ(Gy)
| ||||
---|---|---|---|---|---|---|
Pat #1 | Pat #2 | Pat #3 | Pat #1 | Pat #2 | Pat #3 | |
Bowel (abdominal cavity) | 1.1 | 10.9 | 3.9 | 0.89–0.93 | 8.7–9.0 | 4.6–4.8 |
Brain | 4.5 | 3.2 | 4.6 | 4.3–4.5 | 3.1–3.6 | 4.5–4.6 |
Cord | 3.1 | 6.7 | 6.1 | 3.2–3.6 | 6.69–6.73 | 6.1–6.9 |
Oesophagus | 3.6 | 8.1 | 5.9 | 3.6–3.7 | 7.9–8.0 | 5.7–5.8 |
Heart | 3.3 | 4.6 | 5.4 | 3.26–3.30 | 4.55–4.59 | 5.4–5.5 |
Lacrimal glands | 3.1 | 3.3 | 16.7 | 3.9–4.6 | 3.7–3.8 | 13.3–13.6 |
Lens | 1.9 | 2.2 | 5.9 | 2.1–2.7 | 2.2–2.4 | 6.2–6.5 |
Liver | 2.4 | 4.3 | 4.3 | 2.3–2.4 | 4.2–4.3 | 4.4–4.5 |
Lungs | 2.3 | 3.5 | 3.1 | 2.17–2.20 | 3.36–3.38 | 3.30–3.32 |
Parotids | 20.9 | 19.5 | 18.1 | 19.5–20.3 | 16.7–18.2 | 18.5–18.7 |
Thyroid | 17.5 | 14.4 | 7.5 | 14.1–14.7 | 14.5–14.7 | 6.9–7.0 |
Oral cavity | 5.5 | 2.7 | 2.5 | 5.2–5.5 | 2.69–2.72 | 2.36–2.42 |
Spleen | 2.7 | 4.6 | 9.9 | 2.5–2.6 | 4.3–4.6 | 9.4–9.6 |
Kidneys | 3.1 | 3.8 | 3.3 | 3.0–3.2 | 3.56–3.58 | 3.34–3.39 |
Stomach | 2.4 | 2.1 | 2.1 | 1.6–1.6 | 1.96–1.98 | 2.07–2.11 |
Bladder | 11.0 | 2.6 | 1.4 | 9.1–9.4 | 2.30–2.34 | 1.31–1.31 |
Rectum | 15.9 | 4.8 | 1.6 | 13.6–13.8 | 4.6–4.8 | 1.44–1.46 |
Uterus | 13.8 | / | / | 10.8–11.3 | / | / |
Testicles | / | 27.0 | 18.7 | / | 27.2–28.8 | 19.9–20.2 |
Penis and corpora cavernosa | / | 24.0 | 9.9 | / | 22.3–22.4 | 7.5–8.0 |