Department of Radiation Oncology, Memorial Sloan-Kettering Cancer Center, New York, New York.
Department of Radiation Oncology, Memorial Sloan-Kettering Cancer Center, New York, New York.
Pract Radiat Oncol. 2011 Jul-Sep;1(3):182-7. doi: 10.1016/j.prro.2011.02.010. Epub 2011 Apr 29.
Leukemia cutis (LC) is the infiltration of the epidermis, dermis, or subcutis by neoplastic leukocytes, resulting in clinically identifiable cutaneous lesions. Electron-based radiation therapy (RT) is often used in the treatment of LC; however, modern studies of RT are lacking. We reviewed our experience to analyze treatment response, disease control, and toxicity associated with RT in order to develop treatment recommendations for patients with LC.
Fifteen patients who underwent treatment for LC at our institution from November 1994 to August 2009 were identified and their medical records were reviewed and analyzed.
LC presented after a median of 2 (range 0-24) months from acute myeloid leukemia diagnosis. Median survival from time of LC presentation was 23 months (range 0.5-137 months). Thirteen courses of radiation were administered to 12 patients: 9 total skin electron beam (TSEB) therapy and 4 focal treatments. Of patients receiving TSEB, 89% had diffuse LC involvement and 67% were in marrow remission. By contrast, only 25% of patients receiving focal therapy had diffuse LC involvement and only 25% were in marrow remission. Median TSEB dose was 1600 (range 600-2400) cGy. Fifty percent of patients had a complete response to RT but 1-year local control was only 33%. All patients who developed a skin relapse either had active marrow disease at the time of RT or marrow recurrence shortly thereafter. Median survival since RT was 5 (range 0.5-136) months. RT was well tolerated without significant acute effects; however, 1 patient receiving chemotherapy developed radiation recall 1 month after RT.
Patients with LC have aggressive disease with few long-term survivors. Definitive treatment with TSEB should be utilized only in cases of marrow remission with focal electron therapy reserved for palliation of symptomatic lesions. Long-term prognosis and durable cutaneous remission is dependent on systemic disease control.
白血病皮肤浸润（LC）是指肿瘤白细胞浸润表皮、真皮或皮下组织，导致临床上可识别的皮肤病变。电子放射治疗（RT）常用于 LC 的治疗；然而，现代 RT 研究却缺乏。我们回顾了我们的经验，分析了 RT 治疗的反应、疾病控制和毒性，以便为 LC 患者制定治疗建议。
从 1994 年 11 月至 2009 年 8 月，我们在本机构治疗了 15 例 LC 患者，对其病历进行了回顾和分析。
LC 在急性髓细胞白血病诊断后中位时间 2（范围 0-24）个月出现。从 LC 出现到中位生存时间为 23 个月（范围 0.5-137 个月）。对 12 名患者进行了 13 次放射治疗：9 次全身电子束（TSEB）治疗和 4 次局部治疗。接受 TSEB 的患者中，89%有弥漫性 LC 受累，67%处于骨髓缓解状态。相比之下，只有 25%接受局部治疗的患者有弥漫性 LC 受累，只有 25%处于骨髓缓解状态。TSEB 中位剂量为 1600（范围 600-2400）cGy。50%的患者对 RT 有完全反应，但 1 年局部控制率仅为 33%。所有发生皮肤复发的患者在 RT 时均有活动性骨髓疾病，或随后不久骨髓复发。自 RT 以来的中位生存时间为 5（范围 0.5-136）个月。RT 耐受性良好，无明显急性反应；然而，1 名接受化疗的患者在 RT 后 1 个月发生了辐射回忆反应。
LC 患者疾病侵袭性强，长期生存者少。只有在骨髓缓解的情况下，才应采用全身 TSEB 治疗，而局部电子治疗则应保留用于缓解症状性病变。长期预后和持久的皮肤缓解取决于系统疾病的控制。
