Treatment of cutaneous and/or soft tissue manifestations of corticosteroids refractory chronic graft versus host disease (cGVHD) by a total nodal irradiation (TNI).
The management of corticosteroids refractory chronic graft versus host disease (cGVHD) remains controversial. Retrospective analysis of patients treated at the Integrated Center of Oncology by total nodal irradiation (TNI) was performed to evaluate its therapy potency. TNI delivers a dose of 1 Gy in a single session. The delimitation of the fields is clinical (upper limit: external auditory meatus; lower limit: mid-femur). No pre-therapeutic dosimetry scanner was necessary. Evaluation of the efficacy was by clinical measures at 6 months after the treatment. Twelve patients were treated by TNI between January 2010 and December 2013. TNI was used in second-line treatment or beyond. The median time between allograft and TNI was 31.2 months, and the median time between the first manifestations of cGVHD and TNI was about 24.2 months. Of the 12 patients, nine had a clinical response at 6 months (75%), including five complete clinical responses (41.6%). Five patients could benefit from a reduction of corticosteroid doses. Three patients had hematologic toxicity. TNI could be considered as an option for the treatment of a cutaneous and/or soft tissues corticosteroids refractory cGVHD. However, prospective randomized and double-blind trials remain essential to answer the questions about TNI safety and effectiveness.
Department of Radiotherapy, Integrated Center of Oncology, ICO Paul Papin, Angers, France.
Guillaume
0000-0002-2539-8655
G
Peyraga
Department of Radiotherapy, Integrated Center of Oncology, ICO Paul Papin, Angers, France.
Thibaut
T
Lizee
Department of Radiotherapy, Integrated Center of Oncology, ICO Paul Papin, Angers, France.
Pierre
P
Gustin
Department of Radiotherapy, Integrated Center of Oncology, ICO René Gauducheau, Saint-Herblain, France.
Karen
K
Clement-Colmou
Department of Medical Physics, Integrated Center of Oncology, ICO Paul Papin, Angers, France.
Christelle
C
Di Bartolo
Department of Radiotherapy, Integrated Center of Oncology, ICO René Gauducheau, Saint-Herblain, France.
Stephane
S
Supiot
Department of Radiotherapy, Integrated Center of Oncology, ICO René Gauducheau, Saint-Herblain, France.
Marc-Andre
MA
Mahe
Department of Blood Diseases, University Hospital of Angers, Angers, France.
Sylvie
S
François
Department of Radiotherapy, Integrated Center of Oncology, ICO Paul Papin, Angers, France.
Martine
M
Mege
D000305:Adrenal Cortex Hormones / Q000494:pharmacology*; D000328:Adult; D002908:Chronic Disease; D019008:Drug Resistance, Neoplasm / Q000528:radiation effects*; D005260:Female; D005500:Follow-Up Studies; D006086:Graft vs Host Disease / Q000209:etiology / Q000532:radiotherapy*; D018380:Hematopoietic Stem Cell Transplantation / Q000009:adverse effects*; D006801:Humans; D008198:Lymph Nodes / Q000528:radiation effects*; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D012189:Retrospective Studies; D012871:Skin Diseases / Q000209:etiology / Q000532:radiotherapy*; D012983:Soft Tissue Neoplasms / Q000209:etiology / Q000532:radiotherapy*; D014184:Transplantation, Homologous; D055815:Young Adult
D000305:Adrenal Cortex Hormones
allogeneic hematopoietic stem cell transplantation; chronic graft versus host disease; immunosuppressive therapy; second-line treatment; thoraco-abdominal irradiation; total lymphoid irradiation; total nodal irradiation