Role of radiation therapy in mycosis fungoides refractory to systemic therapy.
ABSTRACT The long natural history of early stage mycosis fungoides (MF) makes its management a difficult problem. Skin lesions are sensitive to different therapies and a variety of treatment modalities have been used, such as topical nitrogen mustard, puvatherapy, UV-B, retinoids, radiation therapy, extracorporal photopheresis and systemic chemotherapy. For patients with refractory early stage MF, treatment selection is made by clinical parameters such as the age, sex and performance status of the patients, as well as the institutional expertise and the toxicity profiles of the different therapeutic approaches. We report radiation therapy in a relapsed/resistant stage IB patient with mycosis fungoides treated with local radiation therapy for symptomatic progression unresponsive to bexarotene therapy. Total skin electron beam therapy has been employed in early stage and for limited skin failure MF, while the role of local radiation therapy in MF is less defined. In our experience local radiotherapy has proved to be a very efficient, tolerable and cost effective approach in patients with MF unresponsive to systemic approaches.
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ABSTRACT: BACKGROUND: Effective nonsurgical modalities are limited in the treatment of basal cell carcinoma (BCC) and squamous cell carcinoma (SCC). OBJECTIVE: We sought to evaluate the efficacy and viability of superficial x-ray therapy in the treatment of BCC and SCC in an outpatient setting. METHODS: A retrospective analysis was performed on 1715 histologically confirmed primary cutaneous BCC and SCC treated with superficial x-ray therapy at Dermatology Associates of Tallahassee in Florida between 2000 and 2010. RESULTS: Of the 1715 tumors reviewed during this period, 712 were histologically proven BCC (631 nodular and 81 superficial), 994 were SCC (861 SCC in situ and 133 invasive SCC), and 9 displayed distinct features of both BCC and SCC in the same biopsy specimen. Kaplan-Meier estimates (with 95% confidence intervals) of cumulative recurrence rates of all tumors at 2 and 5 years were 1.9% (1%-2.7%) and 5.0% (3.2%-6.7%), respectively; of BCC at 2 and 5 years were 2% (0.8%-3.3%) and 4.2% (1.9%-6.4%), respectively; and of all SCC at 2 and 5 years were 1.8% (0.8%-2.8%) and 5.8% (2.9%-8.7%), respectively. Tumors on male patients and those with a diameter greater than 2 cm were associated with a statistically significant increase in recurrence likelihood. LIMITATIONS: This study represents only patients treated in 1 dermatology office in North Florida and may not be representative of the general patient population. CONCLUSIONS: Superficial x-ray therapy remains a viable nonsurgical option for the treatment of primary BCC and SCC in patients where surgical intervention is declined, unadvisable, or potentially associated with significant cosmetic or functional limitations.Journal of the American Academy of Dermatology 07/2012; · 5.00 Impact Factor
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ABSTRACT: Radiotherapy (RT) is one of the treatments of choice as skin-directed therapy in Mycosis Fungoides (MF), both in first stages of the disease as total skin electron beam irradiation and in tumoural stage as localized treatment with conventional energies or electrons. Through a retrospective study, to evaluate the results of localized superficial RT in a series of 100 patients affected by MF. All the patients, after diagnosis supported by histological and immunophenotyping investigations, have been treated with conventional RT (range 50-150 kV) and a total dose ranging from 9 to 40 Gy. Complete remission of the irradiated lesion has been observed in 88%, partial remission in 6% and non-response in 2%. Four patients were lost to follow-up. Local relapse has been observed in 13 lesions, with a local control rate of 85% after 5 years from the end of RT. Cosmetic results have been good and acceptable in 93% of cases. The treatment has been always well tolerated. The results confirm to be dose dependent, and show that better response is found in the range of higher energies. Localized RT is an effective and safe tool in the care and palliation of MF.Journal of the European Academy of Dermatology and Venereology 09/2013; · 2.69 Impact Factor