Melchers Rutger C, Willemze Rein, Daniëls Laurien A, Neelis Karen J, Bekkenk Marcel W, de Haas Ellen R M, Horvath Barbara, van Rossum Michelle M, Sanders Cornelus J G, Velstra Berit, Veraart Joep C J M, Roach Rachel E J, Vermeer Maarten H, Quint Koen D
Department of Dermatology, Leiden University Medical Center, Leiden, The Netherlands.
Department of Dermatology, Leiden University Medical Center, Leiden, The Netherlands.
Int J Radiat Oncol Biol Phys. 2017 Dec 1;99(5):1279-1285. doi: 10.1016/j.ijrobp.2017.08.010. Epub 2017 Aug 24.
To determine the optimal radiation dose for treatment of primary cutaneous anaplastic large cell lymphoma (C-ALCL) with solitary or localized, multifocal or recurrent skin lesions.
In this multicenter study, patients with C-ALCL who had been treated with radiation therapy (RT) between 1984 and 2016 were retrieved from the Dutch registry of cutaneous lymphomas. Distinction was made between patients first presenting with solitary or localized lesions (n=63), with multifocal skin lesions (n=6), and patients with a skin relapse (n=22). Radiation doses, treatment response, and follow-up were evaluated. Radiation doses were categorized as low-dose (≤20 Gy), intermediate-dose (21-39 Gy), and high-dose (≥40 Gy) RT.
Of 63 patients presenting with solitary or localized skin lesions, 61 (97%) showed a complete response (CR). There were no differences in CR between low-dose (16 of 17), intermediate-dose (15 of 15), and high-dose RT (30 of 31). After a median follow-up of 46 months, 30 of 63 patients (48%) had a relapse, but in-field relapses were never observed. Six of 6 patients (100%) initially presenting with multifocal skin lesions showed a CR (3 of 3 low-dose, 2 of 2 intermediate-dose, 1 of 1 high-dose RT). After a median follow-up of 27 months, 3 of 6 patients had a relapse. Treatment of 33 skin relapses in 22 patients showed no differences in CR between low-dose (18 of 19), intermediate-dose (6 of 6), and high-dose RT (8 of 8). In the last 10 years there has been a decrease in radiation dose used in the treatment of C-ALCL. Treatment of multifocal and recurrent lesions with a dose of 8 Gy (2 × 4 Gy) resulted in CR of 17 of 18 lesions.
Our results show that a radiation dose of 20 Gy (8 × 2.5 Gy) is effective in patients presenting with solitary or localized skin lesions. For patients with multifocal skin lesions and patients with a skin relapse, a dose of 8 Gy (2 × 4 Gy) may be sufficient.
确定治疗伴有孤立性或局限性、多灶性或复发性皮肤病变的原发性皮肤间变性大细胞淋巴瘤（C-ALCL）的最佳放射剂量。
在这项多中心研究中，从荷兰皮肤淋巴瘤登记处检索了1984年至2016年间接受放射治疗（RT）的C-ALCL患者。区分首次出现孤立性或局限性病变的患者（n = 63）、有多灶性皮肤病变的患者（n = 6）以及皮肤复发的患者（n = 22）。评估放射剂量、治疗反应和随访情况。放射剂量分为低剂量（≤20 Gy）、中等剂量（21 - 39 Gy）和高剂量（≥40 Gy）放疗。
63例出现孤立性或局限性皮肤病变的患者中，61例（97%）显示完全缓解（CR）。低剂量（17例中的16例）、中等剂量（15例中的15例）和高剂量放疗（31例中的30例）的CR率无差异。中位随访46个月后，63例患者中有30例（48%）复发，但未观察到野内复发。6例最初有多灶性皮肤病变的患者中有6例（100%）显示CR（低剂量3例中的3例、中等剂量2例中的2例、高剂量放疗1例中的1例）。中位随访27个月后，6例患者中有3例复发。对22例患者的33处皮肤复发进行治疗，低剂量（19例中的18例）、中等剂量（6例中的6例）和高剂量放疗（8例中的8例）的CR率无差异。在过去10年中，C-ALCL治疗中使用的放射剂量有所下降。用8 Gy（2×4 Gy）剂量治疗多灶性和复发性病变，18处病变中有17处获得CR。
我们的结果表明，20 Gy（8×2.5 Gy）的放射剂量对出现孤立性或局限性皮肤病变的患者有效。对于有多灶性皮肤病变的患者和皮肤复发的患者，8 Gy（2×4 Gy）的剂量可能足够。
