五例皮肤蕈样霉菌病的全身电子线照射随访结果

目的 报道皮肤蕈样霉菌病的全身电子线照射技术、治疗并发症及近远期疗效。方法 回顾性分析5例皮肤蕈样霉菌病患者的临床资料,并作长期随访。男4例,女1例,中位年龄51岁(14~56岁)。4例患者8周接受30~31.25 Gy/30次的全身电子线照射,另1例患者之前接受了6个周期化疗,后接受8周全身电子线照射31 Gy/31次,残留病灶局部补充电子线剂量至36 Gy。皮肤剂量约为处方剂量的90%,照射野内剂量均匀性控制在处方剂量的±10%以内。结果 放疗后6个月,4例患者疗效评价均为完全缓解,1例为近期治疗,放疗结束时评价为接近完全缓解。急性不良反应可以耐受。2例患者分别于全身电子线治疗后3年和1年死于内脏受累,死亡前皮肤无复发表现,2例患者至随访17年及15年时仍健康存活,1例近期治疗患者放疗结束后2个月仍健康存活。结论 全身电子线照射皮肤蕈样霉菌病局部疗效确切,不良反应可以耐受,脏器侵犯是主要的失败原因。

Follow-up of 5 patients with mycosis fungoides after total skin electron irradiation

Objective To report the total skin electron irradiation(TSEI) to treat the mycosis fungoides and the related acute toxicity, short-term efficacy and long-term results. Methods Five patients with pathologically confirmed mycosis fungoides were enrolled from 1990 to 2011, including 4 males and 1 female. Median age was 51 years old(range 14-56 years old). Dose homegeneity within the field were ±10% of the prescribed dose with a skin surface dose of about 90% of the prescribed dose. Four cases received a total dose of about 30 Gy in 30-32 fractions in 8 weeks, and the other case received an electron boost of 5 Gy to the residual tumor after irradiation with 31 Gy within 31 fractions in 8 weeks,who had received 6 cycles chemotherapy before TSEI. Results 4 cases with a follow-up time of more than 15 years achieved complete response 6 months after radiotherapy. For the recently treated case, a great partial response was achieved after radiotherapy. Acute toxicities for all patients were acceptable. Two patients survived after a follow-up of more than 15 years while the other two cases died of visceral involvement at 1 and 3 years later, respectively. The case treated recently survived 2 months later. Conclusions A total TSEI dose of about 30 Gy within 30-32 fractions during 8 weeks could be proved to be very effective and safe in skin lesion control. Visceral involvement is the main failure type.