Recommendations for the optimal radiation dose in patients with primary cutaneous anaplastic large cell lymphoma: A report of the Dutch Cutaneous Lymphoma Group

Publication date: Available online 24 August 2017
Source:International Journal of Radiation Oncology*Biology*Physics
Author(s): Rutger C. Melchers, Rein Willemze, Laurien A. Daniëls, Karen J. Neelis, Marcel W. Bekkenk, Ellen R.M. de Haas, Barbara Horvath, Michelle M. van Rossum, Cornelus J.G. Sanders, Berit Velstra, Joep C.J.M. Veraart, Rachel E.J. Roach, Maarten H. Vermeer, Koen D. Quint
ObjectiveTo 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.Materials and MethodsIn this multicenter study, patients with C-ALCL, who had been treated with radiotherapy (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 (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 in low-dose (≤20 Gy), intermediate dose (21-39 Gy) and high-dose (≥40 Gy).Results61/63 (97%) patients presenting with solitary or localized skin lesions showed a complete response (CR). There were no differences in CR between low-dose (16/17), intermediate dose (15/15) and high-dose RT (30/31). After a median follow-up of 46 months, 30 of 63 (48%) patients had a relapse, but infield relapses were never observed. Six out of 6 (100%) patients initially presenting with multifocal skin lesions showed a CR (3/3 low-dose, 2/2 intermediate dose, 1/1 high-dose). 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 (18/19), intermediate dose (6/6) and high-dose radiotherapy (8/8).In the last ten 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 (2x4 Gy) resulted in CR of 17/18 lesions.ConclusionOur results show that a radiation dose of 20 Gy (8x2.5 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 (2x4 Gy) may be sufficient.

Teaser

Radiotherapy is the first choice of treatment in primary cutaneous anaplastic large cell lymphoma (C-ALCL), but the optimal dose has yet to be defined. Based on the evaluation of 114 radiation fields in 78 C-ALCL patients, we recommend a dose of 20 Gy for the initial treatment of solitary or localized skin lesions and a dose of 8 Gy for initial treatment of multifocal lesions and for recurrent lesions.


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