Total Skin Electron Irradiation: Efficacy in Early Mycosis Fungoides

The rare, indolent, but lethal malignancy, mycosis fungoides (MF), is amenable to durable remissions if treated topically at an early stage with nitrogen mustard, PUVA, or radiotherapy. A modification of conventional therapeutic irradiation which utilizes electron beams rather than photons, has been in use since 1951. This method, termed total skin electron irradiation (TSEI), has achieved consistently good CR rates (95-100%) at a variety of centres in the U.S.A., England, France, and Italy, despite troublesome differences in staging systems. In northern Israel we have treated 37 MF patients with TSEI during the past 13 years. All 21 of our early stage patients achieved CR, which is no longer regarded as an unusual result. However, most workers in the field acknowledge that issues of optimal dosing and curative potency remain unresolved.     

全身皮肤电子束照射中剂量监测的意义

目的：通过对全身皮肤电子束照射(TSEI)的急性毒性反应的观察，分析热释光(TLD)剂量监测的临床意义。材料与方法：1995年12月至2002年12月利用Varian Clinac2100C电子直线加速器的6MeV电子束高剂量率治疗模式(HDTSe 6MeV)治疗9例患者，利用热释光剂量计测量剂量累积因子MF．利用电离室测量不同厚度散射屏的皮肤表面剂量及治疗深度，对治疗中的8个患者进行18个解剖部位的TLD剂量监测，治疗周剂量5Gy～6Gv。结果：测得的MF值为2．7。不同厚度散射屏的皮肤表面剂量及治疗深度分别为87．5％～96％、13．5mm～6．5mm。全身皮肤电子束照射对皮肤T细胞淋巴瘤可得到良好的控制效果；急性毒性反应限于皮肤及附属器、手足．热释光监测结果与急性反应相符．结论：通过剂量的测量，可以准确给予患者处方刺量，指导临床根据病变的分期选择适当的散射屏，疗中TLD剂量监测对手指、足背防护及治疗后头项．腋下、会阴、足底补量照射有指导意义，对肥胖患者应行大腿内侧补量。