Department of Radiation Oncology, University of Toronto, Faculty of Medicine, Odette Cancer Centre, Sunnybrook Health Sciences Centre, Toronto, ON.
Curr Oncol. 2008 Oct;15(5):229-33. doi: 10.3747/co.v15i5.196.
Patients with chronic lymphocytic leukemia (CLL) are at a significantly increased risk of developing cutaneous squamous cell carcinoma (SCC), in part because of their impaired immunosurveillance. Here, we report the cases of 4 patients with CLL who had locally aggressive cutaneous scc managed with radiotherapy for local recurrence following surgical excision. All tumours were located in the head-and-neck region. All patients initially achieved complete regression of disease; however, 2 had local recurrence a mean of 8 months after treatment completion. One patient died from progressive SCC. Our findings agree with the high rates reported in literature of multiple tumours, local recurrence, metastases, and mortality from scc in patients with cll. Radiotherapy plays an important role in patient management, and it is the recommended treatment modality when complete surgical excision of disease would result in anatomic and functional defects. Radiotherapy is often used in the case of local recurrence after one or more attempts at surgical excision. Dose escalation through intensity-modulated radiotherapy, hyperfractionation, or novel treatment techniques such as high-intensity focused ultrasound may be explored to improve local control of scc lesions. To optimize patient outcomes, cutaneous SCC arising in patients with a history of cll should be managed and followed in a multidisciplinary clinic, with regular skin surveillance and prompt treatment.
患有慢性淋巴细胞白血病（CLL）的患者发生皮肤鳞状细胞癌（SCC）的风险显著增加，部分原因是其免疫监视受损。在这里，我们报告了 4 例 CLL 患者的病例，这些患者在手术切除后局部复发时接受了放疗来治疗局部侵袭性皮肤 SCC。所有肿瘤均位于头颈部。所有患者最初均实现了疾病的完全消退；然而，2 例在治疗完成后平均 8 个月出现局部复发。1 例患者死于 SCC 进展。我们的发现与文献中报告的 CLL 患者 SCC 发生多灶性、局部复发、转移和死亡率高的情况一致。放疗在患者管理中发挥着重要作用，当完全手术切除疾病会导致解剖和功能缺陷时，它是推荐的治疗方式。在尝试手术切除一次或多次后出现局部复发时，通常会采用放疗。通过强度调制放疗、超分割或高强度聚焦超声等新的治疗技术进行剂量升级，可能有助于改善 SCC 病变的局部控制。为了优化患者的预后，应在多学科诊所中对有 CLL 病史的患者进行 SCC 的管理和随访，定期进行皮肤监测并及时进行治疗。
