title: Helical irradiation of the total skin with dose painting to replace total skin electron beam therapy for therapy-refractory cutaneous CD4+ T-cell lymphoma.
abstract: A 36-year-old woman was diagnosed with a therapy-refractory cutaneous CD4+ T-cell lymphoma, T3N0M0B0, and stage IIB. Helical irradiation of the total skin (HITS) and dose painting techniques, with 30 Gy in 40 fractions interrupted at 20 fractions with one week resting, 4 times per week were prescribed. The diving suit was dressed whole body to increase the superficial dose and using central core complete block (CCCB) technique for reducing the internal organ dose. The mean doses of critical organs of head, chest, and abdomen were 2.1 to 29.9 Gy, 2.9 to 8.1 Gy, and 3.6 to 15.7 Gy, respectively. The mean dose of lesions was 84.0 cGy. The dosage of left side pretreated area was decreased 57%. The tumor regressed progressively without further noduloplaques. During the HITS procedure, most toxicity was grade I except leukocytopenia with grade 3. No epitheliolysis, phlyctenules, tumor lysis syndrome, fever, vomiting, dyspnea, edema of the extremities, or diarrhea occurred during the treatment. HITS with dose painting techniques provides precise dosage delivery with impressive results, sparing critical organs, and offering limited transient and chronic sequelae for previously locally irradiated, therapy-refractory cutaneous T-cell lymphoma.
authors.affiliation: Division of Radiation Oncology, Department of Radiology, Far Eastern Memorial Hospital, No. 21, Section 2, Nanya S. Road, Banciao District, New Taipei City 220, Taiwan ; Department of Medicine, School of Medicine, National Yang-Ming University, Taipei 112, Taiwan ; Institute of Traditional Medicine, School of Medicine, National Yang-Ming University, Taipei 112, Taiwan.
authors.forename: Chen-Hsi
authors.initials: CH
authors.lastname: Hsieh
authors.forename: Pei-Wei
authors.initials: PW
authors.lastname: Shueng
authors.forename: Shih-Chiang
authors.initials: SC
authors.lastname: Lin
authors.forename: Hui-Ju
authors.initials: HJ
authors.lastname: Tien
authors.forename: An-Cheng
authors.initials: AC
authors.lastname: Shiau
authors.forename: Yueh-Hung
authors.initials: YH
authors.lastname: Chou
authors.forename: Meng-Hao
authors.initials: MH
authors.lastname: Wu
authors.forename: Jen-Yu
authors.initials: JY
authors.lastname: Wang
authors.forename: Chi-Kuan
authors.initials: CK
authors.lastname: Chen
authors.forename: Yu-Jen
authors.initials: YJ
authors.lastname: Chen
mesh_terms: D000328:Adult; D015496:CD4-Positive T-Lymphocytes; D005260:Female; D006801:Humans; D016410:Lymphoma, T-Cell, Cutaneous / Q000473:pathology / Q000532:radiotherapy*; D061089:Radiotherapy, Image-Guided; D050397:Radiotherapy, Intensity-Modulated; D012878:Skin Neoplasms / Q000473:pathology / Q000532:radiotherapy*