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Total skin electron beam therapy as palliative treatment for cutaneous manifestations of advanced, therapy-refractory cutaneous lymphoma and leukemia  [cached]
Hauswald Henrik,Zwicker Felix,Rochet Nathalie,Uhl Matthias
Radiation Oncology , 2012, DOI: 10.1186/1748-717x-7-118
Abstract: Background To retrospectively access the outcome and toxicity of a total skin electron beam therapy (TSEBT) in patients with cutaneous lymphoma (CL) or leukemia. Patients and methods Treatment results of 25 patients (median age 63 years; 5 female, 20 male) with cutaneous manifestations of advanced and therapy-refractory CL (n = 21; T-cell lymphomas n = 18, B-cell lymphomas n = 3) stage IIB-IV or leukemia (n = 4; AML n = 2, CLL n = 1, PDC n = 1) treated between 1993 and 2010 were reviewed. All patients were symptomatic. The median total dose was 29Gy, applied in 29 fractions of median 1 Gy each. Results The median follow-up was 10 months. Palliation was achieved in 23 patients (92%). A clinical complete response was documented in 13 (52%) and a partial response in 10 patients (40%). The median time to skin progression was 5 months (range 1–18 months) and the actuarial one-year progression-free survival 35%. The median overall survival (OS) after the initiation of TSEBT was 10 months (range 1–46 months) and the actuarial one-year OS 45%. TSEBT related acute adverse events (grade 1 or 2) were observed in all patients during the treatment period. An acute grade 3 epitheliolysis developed in eight patients (32%). Long-term adverse events as a hyperpigmentation of the skin (grade 1 or 2) were documented in 19 patients (76%), and a hypohidrosis in seven patients (28%). Conclusion For palliation of symptomatic cutaneous manifestations of advanced cutaneous lymphoma or leukemia, total skin electron beam therapy is an efficient and well tolerated considerable treatment option.
Primary cutaneous anaplastic large cell lymphoma arising from lymphomatoid papulosis, responding to low dose methotrexate  [cached]
Nandini A,Mysore Venkatram,Sacchidanand S,Chandra Suresh
Journal of Cutaneous and Aesthetic Surgery , 2009,
Abstract: CD301 cutaneous lymphoproliferative disorders (CLPDs) present variable clinical and histological manifestations. We report here a case of an adult male patient who progressed from lymphomatoid papulosis to anaplastic large cell lymphoma. The patient responded satisfactorily to a low dose of methotrexate.
Skin dose estimation for various beam modifiers and source-to-surface distances for 6MV photons
Yadav Girigesh,Yadav R,Kumar Alok
Journal of Medical Physics , 2009,
Abstract: The purpose of this study was to learn the skin dose estimation for various beam modifiers at various source-to-surface distances (SSDs) for a 6 MV photon. Surface and buildup region doses were measured with an acrylic slab phantom and Markus 0.055 cc parallel plate (PP) ionization chamber. Measurements were carried out for open fields, motorized wedge fields, acrylic block tray fields ranging from 3 x 3 cm 2 to 30 x 30 cm 2 . Twenty-five percent of the field was blocked with a cerrobend block and a Multileaf collimator (MLC). The effect of the blocks on the skin dose was measured for a 20 x 20 cm 2 field size, at 80 cm, 100 cm and 120 cm SSD. During the use of isocentric treatments, whereby the tumor is positioned at 100 cm from the source, depending on the depth of the tumor and size of the patient, the SSD can vary from 80 cm to 100 cm. To achieve a larger field size, the SSD can also be extended up to 120 cm at times. The skin dose increased as field size increased. The skin dose for the open 10 x10 cm 2 field was 15.5%, 14.8% and 15.5% at 80 cm, 100 cm and 120 cm SSDs, respectively. The skin dose due to a motorized 60 0 wedge for the 10 x 10 cm 2 field was 9.9%, 9.5%, and 9.5% at 80 cm, 100 cm and 120 cm SSDs. The skin dose due to acrylic block tray, of thickness 1.0 cm for a 10 x 10 cm 2 field was 27.0%, 17.2% and 16.1% at 80, 100 and 120 cm SSD respectively. Due to the use of an acrylic block tray, the surface dose was increased for all field sizes at the above three SSDs and the percentage skin dose was more dominant at the lower SSD and larger field size. The skin dose for a 30 x 30 cm 2 field size at 80 cm SSD was 38.3% and it was 70.4% for the open and acrylic block tray fields, respectively. The skin doses for motorized wedge fields were lower than for open fields. The effect of SSDs on the surface dose for motorized 60° wedge fields was not significant for a small field size (difference was less than 1% up to a 15 x 15 cm 2 field size), but for a larger field (field size more than 15 x 15 cm 2 ), the difference in a percentage skin dose was significant. The skin dose for the open field was more than that for the MLC blocked field and lower than that for the acrylic blocked tray field. The block was 25% of the 20 x 20 cm 2 open field. Skin doses were increased as the SSD decreased and were dominant for larger field sizes. The surface dose was weakly dependent on the MLC block.
Comparison of Adsorbed Skin Dose Received by Patients in Cone Beam Computed Tomography, Spiral and Conventional Computed Tomography Scanninng  [PDF]
Ghazi Khanlou Sani K,Eskandarlou A,Rostampour N,Rahimi A
Journal of Dental Medicine , 2011,
Abstract: Background and Aims: The evaluation of absorbed dose received by patients could give useful information for radiation risk estimation. This study was performed to compare the entrance skin dose received by patients in cone beam computed tomography (CBCT), conventional and spiral computed tomography (CT).Materials and Methods: In this experimental study, 81 calibrated TLD chips were used. the TLD chips were placed on facial, thyroid and end of sternum skin surface in patients referred for CT of the paranasal sinuses(3 TLD chips for each area) to estimate the absorbed dose received by central part of radiation field, thyroid and out of field areas, respectively. The data were analyzed using one-way ANOVA and Tukey tests. Results: The dose delivered to the center of irradiated field was about 0.79±0.09 mGy in CBCT technique compared with 16.31±3.71 and 18.84±4.12 mGy for spiral and conventional CT, respectively. The received dose by the out of field areas was about 54 percent of central area dose. There was statistical significant relationship between the imaging modalities and absorbed dose received by patients (P=0.016). The least absorbed dose was for CBCT and the greatest dose was for conventional CT imaging technique.Conclusion: The dose delivered to central area of irradiated field in conventional and spiral CT imaging modalities was about 24 times greater than of that in CBCT. Also, the highest received dose was for central area of radiated field and the lowest dose was for the out of field areas.
Efficacy and Side Effects of Narrowband-UVB in Early Stage Cutaneous T-Cell Lymphoma in Jordanian Patients  [PDF]
Salah A. Abdallat,Ayman S. Alqaqaa,Nidal A. Obaidat,Rameh F. Alnueimi
ISRN Dermatology , 2014, DOI: 10.1155/2014/951821
Abstract: Background. Many studies, on light-skinned patients, suggested narrowband-UVB to be effective and safe for the treatment of early stage cutaneous T-cell lymphoma. Objectives. To evaluate the efficacy and side effects of narrowband-UVB in treatment of early stage cutaneous T-cell lymphoma in patients with skin phototypes III, IV, and V. Methods. A total of 27 patients with the diagnosis of early stage cutaneous T-cell lymphoma were involved in this prospective study. All patients received narrowband-UVB as monotherapy until clearance or a maximum of 42 sessions. Patients with complete clearance were followed for six months or relapse. Rate of clearance, number of sessions, and cumulative narrowband-UVB dose needed to achieve clearance, percentage of patients remaining in remission at 6 months, and side effects were analyzed. Results. Within 5–14 weeks (15–42 sessions), using cumulative narrowband-UVB dose ranging from 17.3 to 48.2?J/cm2, complete remission was achieved in 76.4% of patients. The rest of the patients achieved partial remission. Six months after discontinuation of the treatment, 42.8% of patients with complete remission remained in remission. Transient erythema in 11.1% of patients and mild hyperpigmentation in 14.8% of patients were the only side effects encountered during this study. Conclusion. We conclude that narrowband-UVB phototherapy is safe and effective for the treatment of early stage cutaneous T-cell lymphoma in darker-skinned patients. 1. Introduction Cutaneous T-cell lymphoma (CTCL) is a group of lymphoproliferative disorders with clonal expansion of T helper cells, or rarely T suppressor/killer cells or NK cells, with localization to the skin. This group is characterized by an increased CD4+ cells: CD4/CD8 > 10, and/or an expansion of T cells with a loss of 1 or more of the normal T-cell antigens (CD2, CD3, and CD5) [1]. Cutaneous T-cell lymphomas are very rare, with a prevalence of 5/1000000 per year [1, 2]. They are classified into a group with indolent clinical behavior, which includes mycosis fungoides (MF) and its variants (62%), and primary cutaneous CD30+ lymphoproliferative disorders (26%) and a group with aggressive clinical behavior (12%) like Sézary syndrome and adult T-cell leukemia/lymphoma [2]. MF, the commonest form of CTCL, presents as patches and plaques over trunk and proximal extremities, without internal involvement. It has a predilection for older adults and male gender [3–5]. MF is classified into early (stage IA, IB, and IIA) and advanced (stage IIB, III and IV) stages [2, 3]. In early stages, the
Cutaneous lesions as presentation form of mantle cell lymphoma  [cached]
Nayra Merino de Paz,Marina Rodriguez-Martin,Patricia Contreras Ferrer,Sonia Garcia-Hernandez
Dermatology Reports , 2011, DOI: 10.4081/dr.2011.e51
Abstract: Mantle cell lymphoma is a type of no-Hodgkin lymphoma that affects extranodal areas, especially, bone narrow, digestive tract and Waldeyer ring. Here we report a case of mantle cell lymphoma IV Ann Arbor stage with cutaneous lesions on nasal dorsum and gland as the first manifestations. Skin involvement is a very rare manifestation and less than 20 cases have been reported in the literature. The importance of stablishing multidisciplinary relationships for a global approach has been shown by this clinical case.
Cutaneous T-Cell Lymphoma in Asians  [PDF]
Min Soo Jang,Dong Young Kang,Jong Bin Park,Sang Tae Kim,Kee Suck Suh
ISRN Dermatology , 2012, DOI: 10.5402/2012/575120
Abstract: Cutaneous T-cell lymphoma describes a heterogeneous group of neoplasms of skin homing T cells that vary considerably in clinical presentation, histologic appearance, immunophenotype, and prognosis. This paper addresses the cutaneous T-cell lymphoma in Asians with respect to clinical-epidemiologic and histopathological features. Compared with Western countries, Asia usually has higher rates of cutaneous T-cell lymphomas such as extranodal NK/T-cell lymphoma, hydroa vacciniforme-like lymphoma, subcutaneous panniculitis T-cell lymphoma, and adult T-cell leukemia/lymphoma and lower rates of cutaneous B-cell lymphomas. Among many variants of mycosis fungoides, hypopigmented lesions, pityriasis lichenoides-like lesions, and ichthyosiform lesions are more prevalent in Asia than in the West. Adult T-cell leukemia/lymphoma is endemic in southwestern Japan especially in the Kyushu island. The clinicopathologic characteristics of cutaneous lymphoma vary according to geography, and this may be ascribed to genetic and environmental etiologic factors. 1. Introduction Cutaneous T-cell lymphomas (CTCLs) are non-Hodgkin lymphomas characterized by a dominant skin-homing T-cell clone with differing clinical presentations, histologic features, and therapeutic considerations. The reported incidence of these cancers has risen sharply over the past 15 years, which may be due to a combination of real increases in cases and improved access to and detection by medical practitioners [1]. The Korean dermatopathology research group reviewed nationwide collection of 80 cutaneous lymphoma cases in Korea. In this study, the most frequent cutaneous lymphoma was mycosis fungoides (42.5%), followed by anaplastic large cell lymphoma (19%), NK/T-cell lymphoma (15%), subcutaneous panniculitis-like T-cell lymphoma (11%), and cutaneous B-cell lymphomas (4%) [2]. Fujita et al. [3] reviewed 106 primary cutaneous lymphoma cases from a single Japanese medical center according to the revised 2008 WHO classification: cutaneous lymphomas comprised mycosis fungoides (52%), CD30 positive T-cell lymphoproliferative disorder (16%), adult T-cell leukemia/lymphoma (6%), NK/T-cell lymphoma (4%), subcutaneous panniculitis-like T-cell lymphoma (3%), and mature B-cell neoplasms (13%). As a whole, mature T-cell and NK-cell neoplasms were frequent (87%) because of the occurrence of adult T-cell leukemia/lymphoma and extranodal NK/T-cell lymphoma, nasal type, with less frequent occurrence of mature B-cell neoplasms (13%). Therefore, compared with Western countries, Korea and Japan usually had higher rates of
Cutaneous T-Cell Lymphoma : An Unusual Presentation  [cached]
Joshi Arun,Sah Shatrughan P,Rani Sudha,Kalra O P
Indian Journal of Dermatology , 2002,
Abstract: A 38 year old Nepalese man presented with a large red tender plaque on his back of 15 days duration. He had a history of fever, cough, chest pain and haemoptysis for 4 months. On examination, he also had pallor lymphadenopathy and hepatomegaly. Investigations revealed anaemia, marked leucocytosis with 45% atypical cells and thrombocytopenia. Chest X-ray showed consolidation and bone marrow examination revealed abnormal cells. Skin biopsy had features of cutaneous T-cell lymphoma (CTCL). We report this rare presentation of CTCL with simultaneous visceral and haematological involvement.
Extrinsic apoptotic pathways: A new potential "Target" for more sufficient therapy in a case of cutaneous anaplastic large CD30+ ALK-T--cell lymphoma
Georgi Tchernev,Carlos Cardoso,Lubomir Arseniev,Hiroyuki Okamoto
Indian Journal of Dermatology , 2011,
Abstract: The primary cutaneous T-cell lymphomas (CTCL) represent a clonal T-lymphocyte proliferation infiltrating the skin. CD30+ T-cell lymphomas present clinically as nodules with a diameter between 1 and 15 cm, mostly in elderly patients. The role of the CD30 molecule in patients suffering from T-cell lymphomas is not completely clear yet. The signal transduction pathway which includes CD30 seems to play a key role in tumor progression. In certain forms of T-cellular lymphomas, the interaction between CD30/CD30-ligand is able to provoke apoptosis of the "tumor lymphocytes". The modern conceptions of the pathogenesis of T-cell lymphomas include disorders in the pathways involved in programmed cellular death and disregulation in the expression of certain of its regulatory molecules. We are presenting an unusual case of a female patient with a primary cutaneous form of CD30 + /ALK anaplastic large T-cell lymphoma. Upon the introduction of systemic PUVA, (psoralen plus ultraviolet light radiation) combined with beam therapy, a complete remission could be noticed. Eight months later, we observed a local recurrence, which was overcome by CHOP chemotherapy (Cyclophosphamide, Hydroxydaunorubicin (Doxorubicin), Vincristin (Oncovin ), Predniso(lo)n). Six months later, new cutaneous lesions had been noticed again. A new therapeutic hope for the patients with anaplastic large CTCL is actually based on the influence of the activity of the different apoptotic pathways. Death ligands, including tumor necrosis factor (TNF)-α, CD95L/FasL, and TRAIL, mediate also some important safeguard mechanisms against tumor growth in patients with CD30 + cutaneous anaplastic large T-cell lymphomas and critically contribute to lymphocyte homeostasis.
Cutaneous lymphoma mimicking seborrhoeic dermatitis  [cached]
Venkateswaran Sri,Garg B,Reddy B,Narasimhan R
Indian Journal of Dermatology, Venereology and Leprology , 1995,
Abstract: A case of non Hodgkins lymphoma presenting with cutaneous lesions mimicking seborrhoeic dermatitis is reported. Clinician should have a high index of suspicion to diagnose lymphoma in its early stage, since it can mimic many benign dermatoses.
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