Radiation Therapy for Chemotherapy Refractory Gingival Myeloid Sarcoma

Gingival myeloid sarcoma (MS) refractory to induction chemotherapy is a rare clinical entity and can be treated with palliative radiation therapy (RT). However, there are few previously published reports of RT approaches for the treatment of gingival MS. We present a single institution retrospective observational study of adult patients treated with palliative RT for chemotherapy refractory gingival MS. A total of six patients diagnosed with gingival MS in the setting of relapsed or refractory acute myeloid leukemia treated with palliative RT were identified, with a median age of 66 (range 52–77). Patients were treated with radiation doses ranging from 5 to 20 Gy in 2–10 fractions. Two patients had adequate follow-up time to assess treatment response. One patient who was simulated with PET/CT experienced a local complete response, while the other patient required retreatment 2 months after initial treatment and experienced an eventual local partial response. Three patients experienced radiation mucositis, with one patient experiencing grade 5 toxicity attributed to concomitant treatment with the radiosensitizer hydroxyurea. We believe that this study can provide a practical reference point for other clinicians given the rarity of gingival MS requiring palliative radiation therapy as a clinical entity.

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Complete response of pleural effusions caused by extramedullary hematopoiesis to low-dose, single fraction palliative radiation therapy: Case report and literature review

Advances in Radiation Oncology ◽

10.1016/j.adro.2018.04.012 ◽

2018 ◽

Vol 3 (3) ◽

pp. 463-466

Author(s):

Hunter C. Gits ◽

Scott C. Lester ◽

Laura A. McGrath ◽

James A. Martenson

Keyword(s):

Radiation Therapy ◽

Case Report ◽

Literature Review ◽

Low Dose ◽

Complete Response ◽

Extramedullary Hematopoiesis ◽

Pleural Effusions ◽

Single Fraction ◽

Palliative Radiation ◽

Palliative Radiation Therapy

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Single-Fraction Radiotherapy for CD30+Lymphoproliferative Disorders

BioMed Research International ◽

10.1155/2015/629587 ◽

2015 ◽

Vol 2015 ◽

pp. 1-10 ◽

Cited By ~ 7

Author(s):

Michelle S. Gentile ◽

Maria Estela Martinez-Escala ◽

Tarita O. Thomas ◽

Joan Guitart ◽

Steven Rosen ◽

...

Keyword(s):

Radiation Therapy ◽

T Cell ◽

Lymphoproliferative Disorder ◽

Cell Lymphoma ◽

Complete Response ◽

Cutaneous T Cell Lymphoma ◽

First Line ◽

Single Fraction ◽

Palliative Radiation ◽

Palliative Radiation Therapy

Objectives. CD30+lymphoproliferative disorder is a rare variant of cutaneous T-cell lymphoma. Sustained complete response following first-line treatments is rare. This retrospective review evaluates the response of refractory or recurrent lesions to palliative radiation therapy.Methods. The records of 6 patients with 12 lesions, treated with radiation therapy, were reviewed. All patients received previous first-line treatments. Patients with clinical and pathological evidence of symptomatic CD30+lymphoproliferative disorder, with no history of other cutaneous T-cell lymphoma variants, and with no prior radiation therapy to the index site were included.Results. The median age of patients was 50.5 years (range, 15–83 years). Median size of the treated lesions was 2.5 cm (range, 2–7 cm). Four sites were treated with a single fraction of 750–800 cGy (n=3) and 8 sites were treated with 4000–4500 cGy in 200–250 cGy fractions (n=3). Radiation therapy was administered with electrons and bolus. Median follow-up was 113 months (range, 16–147 months). For all sites, there was 100% complete response with acute grade 1-2 dermatitis.Conclusions. For recurrent and symptomatic radiation-naïve CD30+lymphoproliferative disorder lesions, palliative radiation therapy shows excellent response. A single fraction of 750–800 cGy is as effective as a multifractionated course and more convenient.

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Outcome of patients treated with a single-fraction dose of radiation for lymphomatoid papulosis.

Journal of Clinical Oncology ◽

10.1200/jco.2012.30.15_suppl.e18523 ◽

2012 ◽

Vol 30 (15_suppl) ◽

pp. e18523-e18523

Author(s):

Michelle Sara Gentile ◽

Tarita O. Thomas ◽

Priya Agrawal ◽

Joan Guitart ◽

Steven T. Rosen ◽

...

Keyword(s):

Radiation Therapy ◽

Cost Effective ◽

Patient Characteristics ◽

Complete Response ◽

Lymphomatoid Papulosis ◽

Single Fraction ◽

Palliative Radiation ◽

Palliative Radiation Therapy ◽

Male Patients ◽

Fraction Dose

e18523 Background: Lymphomatoid Papulosis (LYP) is a primary cutaneous CD30+ lymphoproliferative disorder and a radiosensitive tumor. Treatment with radiation is typically given in multiple fractions for patients presenting with symptomatic unilesional or multilesional disease. However, a single fraction of radiation is more convenient to the patient. The purpose of this retrospective review was to evaluate the clinical response to a single fraction of radiation for palliation of symptomatic LYP lesions. Methods: The records of 8 (5 female, 3 male) patients with LYP, treated with a single or multi-fractionated palliative radiation therapy between 10/2001 and 9/2011, were reviewed. All patients had received multiple previous treatments such as chemotherapy, PUVA, topical nitrogen mustard, and UVB. A total of 19 sites with disease were given the following single doses: 700 (n=3) and 800 (n=16). In the earlier years, a total of 6 sites with disease were given 250 cGy in 18 fractions for a total dose of 4500 cGy. Radiation therapy was administered with electrons to 20 sites and with photons to 5. A bolus was used in most cases to increase the radiation dosage to the skin. Results: Minimum and median follow-up were 1 and 43 months (range, 1 - 120), respectively. Median age of the patients was 65 (range, 24 - 83). For disease sites receiving a single fraction therapy, a complete response (CR) was seen in 17 of the 19 sites (89.5%), and a partial response (PR) was seen in an additional 2 of the 19 sites (10.5%). Therefore, the overall response rate was 100%. For the disease sites receiving multi-fractionated therapy, a CR was seen in 6 of the 6 sites (100%). Evaluation of patient characteristics and treatment did not reveal any differences between patients achieving a CR or PR. Conclusions: For previously treated, radiation-naıve LYP lesions, palliative radiation therapy with single fractions of 700 - 800 cGy is associated with an excellent CR and is a convenient and cost effective strategy.

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Safety and clinical activity of intratumoral MEDI9197 alone and in combination with durvalumab and/or palliative radiation therapy in patients with advanced solid tumors

Journal for ImmunoTherapy of Cancer ◽

10.1136/jitc-2020-001095 ◽

2020 ◽

Vol 8 (2) ◽

pp. e001095 ◽

Cited By ~ 1

Author(s):

Lillian Siu ◽

Joshua Brody ◽

Shilpa Gupta ◽

Aurélien Marabelle ◽

Antonio Jimeno ◽

...

Keyword(s):

Radiation Therapy ◽

Solid Tumors ◽

Phase 1 ◽

Objective Response ◽

Clinical Activity ◽

Advanced Solid Tumors ◽

Palliative Radiation ◽

Cell Counts ◽

Palliative Radiation Therapy ◽

Grade 3

BackgroundMEDI9197 is an intratumorally administered toll-like receptor 7 and 8 agonist. In mice, MEDI9197 modulated antitumor immune responses, inhibited tumor growth and increased survival. This first-time-in-human, phase 1 study evaluated MEDI9197 with or without the programmed cell death ligand-1 (PD-L1) inhibitor durvalumab and/or palliative radiation therapy (RT) for advanced solid tumors.Patients and methodsEligible patients had at least one cutaneous, subcutaneous, or deep-seated lesion suitable for intratumoral (IT) injection. Dose escalation used a standard 3+3 design. Patients received IT MEDI9197 0.005–0.055 mg with or without RT (part 1), or IT MEDI9197 0.005 or 0.012 mg plus durvalumab 1500 mg intravenous with or without RT (part 3), in 4-week cycles. Primary endpoints were safety and tolerability. Secondary endpoints included pharmacokinetics, pharmacodynamics, and objective response based on Response Evaluation Criteria for Solid Tumors version 1.1. Exploratory endpoints included tumor and peripheral biomarkers that correlate with biological activity or predict response.ResultsFrom November 2015 to March 2018, part 1 enrolled 35 patients and part 3 enrolled 17 patients; five in part 1 and 2 in part 3 received RT. The maximum tolerated dose of MEDI9197 monotherapy was 0.037 mg, with dose-limiting toxicity (DLT) of cytokine release syndrome in two patients (one grade 3, one grade 4) and 0.012 mg in combination with durvalumab 1500 mg with DLT of MEDI9197-related hemorrhagic shock in one patient (grade 5) following liver metastasis rupture after two cycles of MEDI9197. Across parts 1 and 3, the most frequent MEDI9197-related adverse events (AEs) of any grade were fever (56%), fatigue (31%), and nausea (21%). The most frequent MEDI9197-related grade ≥3 events were decreased lymphocytes (15%), neutrophils (10%), and white cell counts (10%). MEDI9197 increased tumoral CD8+ and PD-L1+ cells, inducing type 1 and 2 interferons and Th1 response. There were no objective clinical responses; 10 patients in part 1 and 3 patients in part 3 had stable disease ≥8 weeks.ConclusionIT MEDI9197 was feasible for subcutaneous/cutaneous lesions but AEs precluded its use in deep-seated lesions. Although no patients responded, MEDI9197 induced systemic and intratumoral immune activation, indicating potential value in combination regimens in other patient populations.Trial registration numberNCT02556463.

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