Single-fraction radiation therapy provides highly effective palliation for cutaneous t-cell lymphoma
Int J Radiat Oncol Biol Phys
Purpose/Objective(s): A variety of dose fractionation schemes and techniques have been reported when treating cutaneous T-cell lymphoma (CTCL) lesions for palliation. We sought to report our experience with single-fraction palliative radiation therapy. Materials/Methods: We reviewed 59 lesions in 17 patients with CTCL treated with a single fraction for palliative intent. Tumor characteristics, treatment approach, response to treatment, and toxicity were reviewed. Clinical response to treatment was defined as complete response (CR, 100% reduction), partial response (PR, >50% but <100%), and no response (NR). Results: All lesions were treated to a dose of 8 Gy, with a mean followup for all patients of 8 months (range 1-21 months). One lesion on the left knee was treated with high-dose-rate (HDR) iridium-192 brachytherapy because of its location, depth, irregular shape, and body contour. Another deeper lesion was treated with 6 MV photons, using a 3D plan with a 0.5 cm bolus. All remaining lesions (57) were treated with 6-12 MeVelectrons prescribed to the 90% isodose line, using an en face technique with a 0.5 cm bolus. There was a CR in 56 (94.9%) lesions. Three lesions (5.1%) had an initial PR and were re-treated to a dose of 8Gy in 1 fraction. These lesions went on to have a CR. The time interval between first and second fraction in lesions with PR ranged from 1-4 months. Lesions that had a PR were large (>14 cm) and involved the anterior thigh, posterior thigh, and left buttock region. The thickness of the lesions did not predict for response. Tumor stage lesions responded equally well as plaque or patch lesions. Twelve of these lesions in 3 patients were those that were persistent after total skin electron therapy (TSET) to a dose of 36Gy in 24 fractions. These lesions were in areas of skin folds and were treated 6-8 weeks after completion of TSET. CR was achieved in all these residual lesions with an additional single fraction dose of 8Gy. No treatment related toxicity was observed in any of the patients. Conclusion: This study demonstrates a highly effective palliative approach for treating CTCL lesions with minimal toxicity. Larger lesions may need re-treatment. Treatment after total skin electron therapy is safe and well tolerated.
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