Palliative Therapy for Recalcitrant Cutaneous T-Cell Lymphoma of the Hands and Feet With Low-Dose, High Dose-Rate Brachytherapy

Goddard, Allison L.; Vleugels, Ruth Ann; LeBoeuf, Nicole R.; O’Farrell, Desmond A.; Cormack, Robert A.; Hansen, Jorgen L.; Kupper, Thomas S.; Devlin, Phillip M.

doi:10.1001/jamadermatol.2015.3028

Cited by 19 publications

(15 citation statements)

References 13 publications

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“…Radiotherapy is an effective skin-directed therapy for the treatment of CTCLs 66 , 67 . Lymphocytes are sensitive to radiation therapy.…”

Section: Managementmentioning

confidence: 99%

An overview of cutaneous T cell lymphomas

Bagherani¹,

Smoller

2016

F1000Res

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Cutaneous T cell lymphomas (CTCLs) are a heterogeneous group of extranodal non-Hodgkin’s lymphomas that are characterized by a cutaneous infiltration of malignant monoclonal T lymphocytes. They typically afflict adults with a median age of 55 to 60 years, and the annual incidence is about 0.5 per 100,000. Mycosis fungoides, Sézary syndrome, and primary cutaneous peripheral T cell lymphomas not otherwise specified are the most important subtypes of CTCL. CTCL is a complicated concept in terms of etiopathogenesis, diagnosis, therapy, and prognosis. Herein, we summarize advances which have been achieved in these fields.

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“…Radiotherapy is an effective skin-directed therapy for the treatment of CTCLs 66 , 67 . Lymphocytes are sensitive to radiation therapy.…”

Section: Managementmentioning

confidence: 99%

An overview of cutaneous T cell lymphomas

Bagherani¹,

Smoller

2016

F1000Res

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“…Using standard ALA-PDT, Pileri et al reported partial and complete remissions of MF patches in difficult-to-treat sites (16). Goddard et al have demonstrated that low-dose, high-dose rate brachytherapy, i.e., the administration of radiation via flexible catheters secured within customized surface molds, can lead to prolonged remission in patients with facial and acral CTCL lesions (38,39). Brachytherapy has also been used to treat other skin malignancies, such as squamous and basal cell carcinoma as well as cutaneous metastases of Merkel cell carcinoma (40,41).…”

Section: Discussionmentioning

confidence: 99%

Epigenetically Enhanced PDT Induces Significantly Higher Levels of Multiple Extrinsic Pathway Apoptotic Factors than Standard PDT, Resulting in Greater Extrinsic and Overall Apoptosis of Cutaneous T‐cell Lymphoma

Salva

Kim

Rahbar

et al. 2018

Photochem & Photobiology

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Aminolevulinate-based photodynamic therapy (ALA-PDT) selectively eliminates diseased tissues primarily through the induction of intrinsic apoptotic pathway. ALA-PDT is a first-line therapy for actinic keratosis, however, it is less effective for cutaneous T-cell lymphoma (CTCL). We have previously demonstrated that the resistance of CTCL to apoptosis correlates with decreased expression of death receptors such as FAS, and that methotrexate functions as an epigenetic regulator that reestablishes the susceptibility of CTCL to extrinsic pathway apoptosis. We showed previously that MTX augments the effectiveness of PDT by sensitizing cells to apoptosis by induction of apoptotic factors, a process we call "epigenetically enhanced" PDT (ePDT). Here, in CTCL cell lines, leukemic CTCL cells, and normal blood T cells, we analyzed multiple components of the FAS, TRAIL, and TNF families using multispectral imaging of immunostained cytopreparations, a quantitative technique with five-fold greater sensitivity than standard immunocytology. ePDT induced significantly greater FAS, FASL, TRAIL-R1 & -R2, and TNFα levels than standard PDT. This correlated with significantly greater induction of extrinsic pathway apoptosis and/or overall apoptosis in all CTCL samples. There was no appreciable effect on normal T cells. These data set the stage for clinical trials of ePDT as a novel localized treatment of CTCL.

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“…Goddard et al presented a case series utilizing HDR brachytherapy for the treatment of acral CTCL skin lesions on six patients with eight lesions also treated with 8 Gy in 2 fractions. They reported an 88% control rate with only one lesion recurring locally within a mean follow-up period of 15.8 months [ 16 ]. Our case describes treatment of more extensive CTCL lesions than previously reported.…”

Section: Discussionmentioning

confidence: 99%

“…Patients frequently experience intense pruritus, pain, cracking and bleeding skin, and associated insomnia, depression, and decreased self-esteem [ 17 , 18 ]. Depending on the location of the lesions, patients may have difficulty using their hands or ambulating [ 16 ]. Treatment with radiotherapy improved our patient's symptoms and allowed him to regain his mobility and avoid possible amputation of his afflicted left foot.…”

Section: Discussionmentioning

confidence: 99%

Extensive Cutaneous T-Cell Lymphoma of the Feet Treated with High-Dose-Rate Brachytherapy and External Beam Radiation

Tao

Hentz

Mysz

et al. 2018

Case Reports in Dermatological Medicine

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Cutaneous T-cell lymphoma (CTCL) is a chronic, debilitating disease that has a severe impact on quality of life. We present a patient with multiple CTCL lesions on the bilateral feet, which impaired his ability to ambulate. His lesions on both feet were successfully treated with a total of 8 Gy in two fractions via high-dose-rate surface brachytherapy using the Freiburg Flap applicator. The deeper aspects of the bulkier lesions on the left foot were boosted with electron beam therapy. The radiation therapy was well tolerated, and the patient was able to regain his mobility after completing radiation therapy. To our knowledge, there are few reports utilizing brachytherapy in treating CTCL. Our case describes treatment of larger, more extensive CTCL lesions than previously reported.

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Palliative Therapy for Recalcitrant Cutaneous T-Cell Lymphoma of the Hands and Feet With Low-Dose, High Dose-Rate Brachytherapy

Cited by 19 publications

References 13 publications

An overview of cutaneous T cell lymphomas

An overview of cutaneous T cell lymphomas

Epigenetically Enhanced PDT Induces Significantly Higher Levels of Multiple Extrinsic Pathway Apoptotic Factors than Standard PDT, Resulting in Greater Extrinsic and Overall Apoptosis of Cutaneous T‐cell Lymphoma

Extensive Cutaneous T-Cell Lymphoma of the Feet Treated with High-Dose-Rate Brachytherapy and External Beam Radiation

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