RESUMEN
PURPOSE: Low-dose total skin electron beam therapy (TSEBT) over 3 weeks has proved to be a safe and effective treatment for cutaneous T cell lymphomas (CTCL). In this prospective trial, we examined the feasibility of ultra-hypofractionated low-dose TSEBT regimen in two fractions with 4 Gy combined with systemic therapy to minimize the number of visits to radiation centers. PATIENTS AND METHODS: Six patients with mycosis fungoides (MF) or Sézary syndrome (SS) received TSEBT with a total radiation dose of 8 Gy in two fractions between April 2020 and June 2020. Patient and treatment characteristics, tumor burden, the impact on the quality of life using Skindex-29 questionnaires, and acute toxicities were analyzed. RESULTS: During TSEBT, all patients developed grade 1 toxicities while two patients developed grade 2 toxicities. One patient experienced sepsis. The most common adverse effects were erythema and edema. All grade 2 toxicities regressed after 4 weeks following TSEBT. Based on the reported symptoms measured by Skindex-29, we detected a significant reduction in total Skindex-29 score after 8 weeks of radiation (P = 0.03), particularly in the symptoms (P = 0.01) and emotional domains (P = 0.04). CONCLUSION: Ultra-hypofractionated low-dose TSEBT followed by systemic therapy seems to be a safe and feasible alternative to conventional fractionated TSEBT for patients with MF/SS. The skin tumor burden and the health-related quality of life have been significantly improved within 8 weeks following radiotherapy.
Asunto(s)
Fraccionamiento de la Dosis de Radiación , Linfoma Cutáneo de Células T/radioterapia , Radioterapia Conformacional/métodos , Neoplasias Cutáneas/radioterapia , Anciano , Estudios de Factibilidad , Femenino , Humanos , Linfoma Cutáneo de Células T/complicaciones , Masculino , Persona de Mediana Edad , Micosis Fungoide/complicaciones , Micosis Fungoide/radioterapia , Calidad de Vida , Traumatismos por Radiación/diagnóstico , Traumatismos por Radiación/etiología , Dosificación Radioterapéutica , Radioterapia Conformacional/efectos adversos , Síndrome de Sézary/complicaciones , Síndrome de Sézary/radioterapia , Neoplasias Cutáneas/complicaciones , Resultado del TratamientoAsunto(s)
Dermatitis Exfoliativa/terapia , Síndrome de Sézary/complicaciones , Neoplasias Cutáneas/complicaciones , Infecciones Estafilocócicas/tratamiento farmacológico , Antibacterianos/uso terapéutico , Antiinfecciosos Locales/uso terapéutico , Antiinflamatorios/uso terapéutico , Dermatitis Exfoliativa/etiología , Femenino , Humanos , Hidroterapia , Staphylococcus aureus Resistente a Meticilina , Persona de Mediana Edad , Infecciones Estafilocócicas/complicacionesRESUMEN
BACKGROUND: The purpose of this study was to determine the prevalence of vitamin D deficiency in CTCL patients and whether supplementation corrects vitamin D deficiency or treatment outcome. PATIENTS AND METHODS: Three hundred eleven CTCL patients including 27/311 (8.7%) with Sézary syndrome (SS), 169 cancer controls, and 69 normal controls from the M.D. Anderson clinics had 25(OH)D3 levels determined and categorized as deficient (< 20 ng/mL),insufficient (20-29 ng/mL), or sufficient (≥ 30 ng/mL). Clinical response was determined according to a change in percent body surface area involvement. RESULTS: Low 25(OH)D3 (< 30 ng/mL) levels were present in 76.9% of mycosis fungoides/SS patients, 75.2% of cancer controls, and 66.7% of healthy controls (P » .05, .07) and in 30% to 39% of historical normal controls. Correction of deficiency was successful in 35% or 55 of 156 patients who were given dealer's choice of either vitamin D2 at 50,000 IU orally (p.o.) biweekly or D3 1000 IU p.o. daily. Correction of vitamin D levels was noted in 27 of 100 (27%) patients given D3 and 28 of 56 (50%) given D2. Responses to standard CTCL therapy was similar among patients with corrected and persistently low levels (P » .51). CONCLUSION: To our knowledge,this is the first study of vitamin D status in CTCL patients. Vitamin D deficiency was present in CTCL and other cancer patients compared with normal and historical controls. Correction of vitamin D deficiency and type of vitamin D supplementation used did not affect the overall clinical disease response.
Asunto(s)
Micosis Fungoide/complicaciones , Neoplasias/complicaciones , Síndrome de Sézary/complicaciones , Deficiencia de Vitamina D/complicaciones , Adulto , Anciano , Estudios de Casos y Controles , Suplementos Dietéticos , Femenino , Humanos , Masculino , Persona de Mediana Edad , Micosis Fungoide/diagnóstico , Micosis Fungoide/terapia , Estadificación de Neoplasias , Neoplasias/diagnóstico , Neoplasias/terapia , Síndrome de Sézary/diagnóstico , Síndrome de Sézary/terapia , Resultado del Tratamiento , Vitamina D/administración & dosificación , Vitamina D/sangre , Deficiencia de Vitamina D/diagnóstico , Deficiencia de Vitamina D/tratamiento farmacológico , Adulto JovenRESUMEN
Pruritus has a well-known association with Hodgkin's disease and other nodal lymphomas; indeed it often reveals the disease. Pruritus is also an important symptom of cutaneous T-cell lymphomas. Lymphoma-associated itch is thus both frequent and severe, but its pathophysiology remains unclear. Few studies have evaluated the efficacy of therapeutic agents in the management of cutaneous T-cell lymphoma-related pruritus. The main objective of treatment remains disease control. Pruritus management is generally based on the physician's experience. Treatment is very difficult, especially in Sézary syndrome. We present here management strategies for cutaneous lymphoma-associated pruritus.
Asunto(s)
Antipruriginosos/uso terapéutico , Linfoma Cutáneo de Células T/complicaciones , Prurito/tratamiento farmacológico , Síndrome de Sézary/complicaciones , Neoplasias Cutáneas/complicaciones , Humanos , Linfoma Cutáneo de Células T/terapia , Fototerapia , Prurito/diagnóstico , Prurito/etiología , Prurito/fisiopatología , Índice de Severidad de la Enfermedad , Síndrome de Sézary/terapia , Neoplasias Cutáneas/terapia , Resultado del TratamientoRESUMEN
Disseminated epidermolytic acanthoma was observed during PUVA therapy in a patient with Sézary syndrome. The majority of the lesions resolved within 5 months after the cessation of therapy. This circumstantial evidence together with our knowledge of the effects of PUVA suggest that the skin lesions were revealed by topical photochemotherapy.
Asunto(s)
Terapia PUVA/efectos adversos , Papiloma/etiología , Síndrome de Sézary/complicaciones , Neoplasias Cutáneas/etiología , Humanos , Masculino , Persona de Mediana Edad , Síndrome de Sézary/terapiaRESUMEN
Eighteen patients with erythroderma, recurrent cycles of circulating Sézary cells of less than 1,000 cells/mm3, and a chronic course were followed for a mean time of nearly 5 years and were diagnosed as having pre-Sézary syndrome. Only one patient died, and none developed lymphoproliferative disease. All ten patients who underwent patch testing showed positive results. The elevation of IgE was striking when this group was compared with a group with Sézary syndrome. Most patients achieved partial or complete remission on low-dose chlorambucil and prednisone therapy. Some patients had lymphocytic or lymphomatoid bands on skin biopsy specimens and were like previously reported patients with pre-Sézary syndrome whose condition progressed to Sézary syndrome. A nontoxic chemotherapy or an anti-T cell treatment program can control this chronic erythroderma state.