Micaily B, Miyamoto C, Kantor G, Lessin S, Rook A, Brady L, Goodman R, Vonderheid E C
Department of Radiation Oncology, Allegheny University Hospitals, Hahnemann, Philadelphia, PA 19102, USA.
Int J Radiat Oncol Biol Phys. 1998 Sep 1;42(2):361-4. doi: 10.1016/s0360-3016(98)00218-1.
To evaluate the treatment outcome and natural history of patients with the diagnosis of unilesional mycosis fungoides, treated according to a prospective radiotherapy protocol in our institution since July 1975.
A total of 325 patients with the diagnosis of mycosis fungoides have been referred to the Department of Radiation Oncology at Allegheny University of Health Sciences from July 1975 through September 1996. Of these, 18 patients (5%) were classified as having unilesional mycosis fungoides and were irradiated with a curative intent using local electron fields. One patient received 22 Gy; 1 patient received 40 Gy, and the rest of the patients 30.6 Gy. Daily fractions ranged from 1.8 to 2.0 Gy. Treatments prior to radiation consisted of topical steroids and/or antifungal creams in the majority of patients, with temporary partial responses. One patient had received 2 years of topical mechlorethamine (HN2) and another patient had received topical carmustine solution (BCNU) without response prior to irradiation.
The responses were measured clinically; posttreatment skin biopsy was not performed routinely unless there was clinical evidence of disease persistence. Complete response rate was 100%; all treated lesions cleared completely within 4 to 8 weeks after the completion of radiation. With a median follow-up of 43 months (range 12 to 240 months), 2 relapses have occurred, 2 and 71 months after the completion of radiation. Both relapses were confined to the skin and were remote from the original site. Both relapses responded to topical application of HN2. There have been no recurrences in the irradiated field nor systemic dissemination. No long-term side effects were found related to treatment, and all the patients are currently alive and without evidence of disease. Actuarial relapse-free and overall survival at 10 years are, respectively, 86.2% and 100%.
Unilesional mycosis fungoides has a long natural history, is possibly the earliest manifestation of a malignant process, and local treatments, including local radiotherapy, result in long-term disease-free intervals and, possibly, cure. Total skin electron beam radiotherapy is not indicated for this disease entity.
评估自1975年7月起在我院按照前瞻性放疗方案治疗的单病灶蕈样肉芽肿患者的治疗结果和自然病程。
1975年7月至1996年9月期间，共有325例诊断为蕈样肉芽肿的患者被转诊至阿勒格尼大学健康科学学院放射肿瘤学系。其中，18例（5%）被归类为单病灶蕈样肉芽肿，并采用局部电子线野进行根治性照射。1例患者接受了22 Gy照射；1例患者接受了40 Gy照射，其余患者接受了30.6 Gy照射。每日分次剂量为1.8至2.0 Gy。大多数患者在放疗前接受了局部类固醇和/或抗真菌乳膏治疗，有短暂的部分缓解。1例患者在放疗前接受了2年的局部氮芥（HN2）治疗，另1例患者在放疗前接受了局部卡莫司汀溶液（BCNU）治疗但无反应。
通过临床评估反应；除非有疾病持续的临床证据，否则不常规进行治疗后皮肤活检。完全缓解率为100%；所有治疗的病灶在放疗结束后4至8周内完全消退。中位随访时间为43个月（范围12至240个月），放疗结束后2个月和71个月发生了2次复发。两次复发均局限于皮肤且远离原发病灶。两次复发均对局部应用HN2有反应。照射野内无复发，也无全身播散。未发现与治疗相关的长期副作用，所有患者目前均存活且无疾病证据。10年的精算无复发生存率和总生存率分别为86.2%和100%。
单病灶蕈样肉芽肿自然病程较长，可能是恶性过程的最早表现，局部治疗，包括局部放疗，可导致长期无病间期，甚至可能治愈。对于该疾病实体，不建议采用全身皮肤电子束放疗。
