Parida Dillip K, Verma Kaushal K, Chander Subhash, Joshi R C, Rath Goura K
Department of Radiation Oncology, All India Institute of Medical Sciences, New Delhi, India.
Int J Dermatol. 2005 Oct;44(10):828-30. doi: 10.1111/j.1365-4632.2005.02217.x.
Total skin electron irradiation (TSEI) therapy is the treatment of choice for mycosis fungoides. However, conventional TSEI therapy is time consuming as well as patient unfriendly. Therefore we used high-dose rate (HDR) mode TSEI in these patients. High-dose rate mode of TSEI is a technological innovation attached to a Linear Accelerator (Philips, SL-20, Netherlands), which can deliver an electron beam of 30 Gy/min at the iso-center. The iso-center faces the patient, 100 cm away from the target of the linear accelerator. The patient is treated at a distance of 10 feet from the iso-center of the linear accelerator. The dose delivered to the skin was 1.13 Gy/min, making the treatment execution much easier and patient compliance much better.
Seven male patients between 40 and 64 years in age having mycosis fungoides for 9-18 months were treated by TSEI using high-dose rate mode between 1998 and 2000. The TSEI was performed according to the Stanford technique, delivering a total dose of 36 Gy. Each patient received a dose of 1.2 Gy/field/day. There were six fields, i.e. anterior, posterior, left and right anterior obliques, and left and right posterior obliques in both the upper and lower parts of the body. The eyes and nails were shielded at each session of radiotherapy. The times taken at each session of the therapy and radiation-associated side-effects were determined in each patient. The patients were followed up to 26 months (median 9 months) to look for any relapse.
Three patients had early stage disease (IB) whereas four patients had advanced disease (IIB). Six patients out of these had complete remission following TSEI while one patient died as a result of progression of the disease during treatment. The treatment time taken at each treatment session in each individual patient was approximately 15 min. Radiation-associated morbidity was seen in all patients. Cutaneous lesions relapsed in two patients after 4 and 10 months, respectively, while four patients were alive without the disease at the end of 2 years.
Total skin electron irradiation using high-dose rate mode delivery of electrons is an easy, better, compliant and effective therapeutic modality for treatment of mycosis fungoides with an acceptable range of toxicities.
全身皮肤电子线照射（TSEI）疗法是蕈样肉芽肿的首选治疗方法。然而，传统的TSEI疗法既耗时又对患者不友好。因此，我们在这些患者中采用了高剂量率（HDR）模式的TSEI。TSEI的高剂量率模式是一项附着于直线加速器（飞利浦，SL - 20，荷兰）的技术创新，它可以在等中心处提供30 Gy/分钟的电子束。等中心面向患者，距离直线加速器的靶点100厘米。患者在距离直线加速器等中心10英尺的位置接受治疗。皮肤所接受的剂量为1.13 Gy/分钟，这使得治疗实施起来更加容易，患者的依从性也更好。
1998年至2000年期间，对7名年龄在40至64岁之间、患有蕈样肉芽肿9至18个月的男性患者采用高剂量率模式进行TSEI治疗。TSEI按照斯坦福技术进行，总剂量为36 Gy。每位患者每天每野接受1.2 Gy的剂量。共有六个照射野，即身体上下部的前野、后野、左右前斜野和左右后斜野。每次放疗时均对眼睛和指甲进行防护。确定每位患者每次治疗的时间以及放疗相关的副作用。对患者进行长达26个月（中位时间9个月）的随访，以观察是否有复发情况。
3例患者为早期疾病（IB期），4例患者为晚期疾病（IIB期）。其中6例患者在TSEI治疗后完全缓解，1例患者在治疗期间因疾病进展死亡。每位患者每次治疗的时间约为15分钟。所有患者均出现了放疗相关的并发症。2例患者分别在4个月和10个月后皮肤病变复发，4例患者在2年结束时无病存活。
采用高剂量率模式输送电子的全身皮肤电子线照射是一种简便、更佳、依从性好且有效的治疗蕈样肉芽肿的方法，其毒性在可接受范围内。
