Advertisement

Recommendations for the Optimal Radiation Dose in Patients With Primary Cutaneous Anaplastic Large Cell Lymphoma: A Report of the Dutch Cutaneous Lymphoma Group

      Purpose

      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.

      Methods and Materials

      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.

      Results

      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.

      Conclusions

      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.
      To read this article in full you will need to make a payment
      ASTRO Member Login
      ASTRO Members, full access to the journal is a member benefit. Use your society credentials to access all journal content and features.
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'

      Purchase one-time access:

      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect

      References

        • Willemze R.
        • Jaffe E.S.
        • Burg G.
        • et al.
        WHO-EORTC classification for cutaneous lymphomas.
        Blood. 2005; 105: 3768-3785
        • Bekkenk M.W.
        • Geelen F.A.
        • van Voorst Vader P.C.
        • et al.
        Primary and secondary cutaneous CD30(+) lymphoproliferative disorders: A report from the Dutch Cutaneous Lymphoma Group on the long-term follow-up data of 219 patients and guidelines for diagnosis and treatment.
        Blood. 2000; 95: 3653-3661
        • Querfeld C.
        • Khan I.
        • Mahon B.
        • et al.
        Primary cutaneous and systemic anaplastic large cell lymphoma: Clinicopathologic aspects and therapeutic options.
        Oncology (Williston Park). 2010; 24: 574-587
        • Wieser I.
        • Tetzlaff M.T.
        • Torres Cabala C.A.
        • et al.
        Primary cutaneous CD30(+) lymphoproliferative disorders.
        J Dtsch Dermatol Ges. 2016; 14: 767-782
        • Liu H.L.
        • Hoppe R.T.
        • Kohler S.
        • et al.
        CD30+ cutaneous lymphoproliferative disorders: The Stanford experience in lymphomatoid papulosis and primary cutaneous anaplastic large cell lymphoma.
        J Am Acad Dermatol. 2003; 49: 1049-1058
        • Hapgood G.
        • Pickles T.
        • Sehn L.H.
        • et al.
        Outcome of primary cutaneous anaplastic large cell lymphoma: A 20-year British Columbia Cancer Agency experience.
        Br J Haematol. 2017; 176: 234-240
        • Specht L.
        • Dabaja B.
        • Illidge T.
        • et al.
        Modern radiation therapy for primary cutaneous lymphomas: Field and dose guidelines from the International Lymphoma Radiation Oncology Group.
        Int J Radiat Oncol Biol Phys. 2015; 92: 32-39
        • Kempf W.
        • Pfaltz K.
        • Vermeer M.H.
        • et al.
        EORTC, ISCL, and USCLC consensus recommendations for the treatment of primary cutaneous CD30-positive lymphoproliferative disorders: Lymphomatoid papulosis and primary cutaneous anaplastic large-cell lymphoma.
        Blood. 2011; 118: 4024-4035
        • Willemze R.
        • Hodak E.
        • Zinzani P.L.
        • et al.
        Primary cutaneous lymphomas: ESMO Clinical Practice Guidelines for diagnosis, treatment and follow-up.
        Ann Oncol. 2013; 24: vi149-vi154
        • Yu J.B.
        • McNiff J.M.
        • Lund M.W.
        • et al.
        Treatment of primary cutaneous CD30+ anaplastic large-cell lymphoma with radiation therapy.
        Int J Radiat Oncol Biol Phys. 2008; 70: 1542-1545
        • Huang B.S.
        • Chen W.Y.
        • Wang C.W.
        • et al.
        Relapse pattern and treatment outcome of curative radiotherapy for primary cutaneous CD30+ anaplastic large-cell lymphoma: A retrospective cohort study.
        Acta Derm Venereol. 2016; 96: 394-395
        • Booken N.
        • Goerdt S.
        • Klemke C.D.
        Clinical spectrum of primary cutaneous CD30-positive anaplastic large cell lymphoma: An analysis of the Mannheim Cutaneous Lymphoma Registry.
        J Dtsch Dermatol Ges. 2012; 10: 331-339
        • Million L.
        • Yi E.J.
        • Wu F.
        • et al.
        Radiation therapy for primary cutaneous anaplastic large cell lymphoma: An International Lymphoma Radiation Oncology Group multi-institutional experience.
        Int J Radiat Oncol Biol Phys. 2016; 95: 1454-1459
        • Kim Y.H.
        • Willemze R.
        • Pimpinelli N.
        • et al.
        TNM classification system for primary cutaneous lymphomas other than mycosis fungoides and Sezary syndrome: A proposal of the International Society for Cutaneous Lymphomas (ISCL) and the Cutaneous Lymphoma Task Force of the European Organization of Research and Treatment of Cancer (EORTC).
        Blood. 2007; 110: 479-484
        • Neelis K.J.
        • Schimmel E.C.
        • Vermeer M.H.
        • et al.
        Low-dose palliative radiotherapy for cutaneous B- and T-cell lymphomas.
        Int J Radiat Oncol Biol Phys. 2009; 74: 154-158
        • Thomas T.O.
        • Agrawal P.
        • Guitart J.
        • et al.
        Outcome of patients treated with a single-fraction dose of palliative radiation for cutaneous T-cell lymphoma.
        Int J Radiat Oncol Biol Phys. 2013; 85: 747-753

      Comments

      Commenting Guidelines

      To submit a comment for a journal article, please use the space above and note the following:

      • We will review submitted comments as soon as possible, striving for within two business days.
      • This forum is intended for constructive dialogue. Comments that are commercial or promotional in nature, pertain to specific medical cases, are not relevant to the article for which they have been submitted, or are otherwise inappropriate will not be posted.
      • We require that commenters identify themselves with names and affiliations.
      • Comments must be in compliance with our Terms & Conditions.
      • Comments are not peer-reviewed.