electron beam therapy
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2022 ◽  
pp. 726-741
Author(s):  
Abdullah Essam Kattan ◽  
Aws Abdulrahman Alsuhaibani ◽  
Abdullah Alsuhaibani ◽  
Tareq Salah Hassan

Treatment of keloids is usually challenging, requiring a multimodal approach with no universally accepted treatment modality among the wide range of alternative keloid treatments. Excision of keloid lesion usually eliminates symptoms and it is the main treatment with considerable recurrence rate. Recurrence rate ranges from 45-100% when surgical excision is performed as monotherapy. Furthermore, Recurrent Keloids have a higher recurrence rate after surgery. In this case we discuss a challenging case of young female presented with third recurrence in lobule of the ear with defect necessitated flap reconstruction with concern for possible damage by the flap if radiation was given as external beam postoperatively. Intraoperative electron beam therapy was utilized with high safety and efficacy. To our knowledge this is the first case in the Middle East to use this technique in treating Keloid. Conclusion Treatment of keloids is usually challenging, requiring a multimodal approach. Excision of keloid lesion usually eliminates symptoms and it is the main treatment with considerable recurrence rate .Recurrence rate ranges from 45-100% when surgical excision is performed as monotherapy. Furthermore, Recurrent Keloids have a higher recurrence rate after surgery. Radiation is a valid option for decreasing risk of recurrence in recurrent keloid with high safety and efficacy profile. In this case we discuss a challenging case of young female presented with third recurrence in lobule of the ear with defect necessitated flap reconstruction with concern for possible damage by the flap if radiation was given as external beam postoperatively. Intraoperative electron beam therapy was utilized with high safety and efficacy. To our knowledge this is the first case in the Middle East to use this technique in treating Keloid. Keywords: Keloid; Radiation; Intraoperative Radiation; IOeRT


Blood ◽  
2021 ◽  
Vol 138 (Supplement 1) ◽  
pp. 1372-1372
Author(s):  
Sofia F Yi ◽  
Akshat M Patel ◽  
Syed M Rizvi ◽  
Praveen Ramakrishnan Geethakumari ◽  
Jennifer L Shah ◽  
...  

Abstract Introduction Cutaneous T-cell lymphoma (CTCL) is a rare form of lymphoma that is characterized by the localization of malignant cells to the skin. While considerable advances have been made in both the diagnosis and treatment of this disease, management and long-term disease control continue to be significant challenges. In particular, total skin electron beam therapy (TSEBT)-a technique that allows for homogenous irradiation of the entire skin-has proved to be efficacious for palliatively treating CTCL (Heumann TR et al IJROBP 2015), but a large proportion of patients continue to relapse over time with a limited possibility of retreatment due to skin toxicity (Wilson LD et al J Am Acad Dermatol 1996; Becker M et al IJROBP 1995). Recently, low-dose TSEBT to ~12 Gy has largely replaced traditional TSEBT to ~36 Gy for the palliative treatment of CTCL due to similar high response rate with less toxicity and more room to re-treat as necessary (Hoppe et al J Am Acad Dermatol 2015). However, there is little consensus on the optimal fractionation and dose per fraction (i.e. number of total treatments needed to deliver 12 Gy). At our institution, we have implemented a novel condensed hypofractionated scheme for low-dose TSEBT, where instead of giving ½ cycle (3 positions) per fraction, we give a full cycle (all 6 positions) per fraction, leading to half as many treatments (6 instead of 12) for the same total dose (12 Gy). We hypothesize that condensed low-dose TSEBT given in 6 fractions, compared to 12, will have similar toxicity and efficacy with the additional convenience of half as many treatments. Methods We conducted a single-institution retrospective review of patients with primary CTCL who received TSEBT at UT Southwestern between 2012 and 2021. We stratified patients based on whether they received high-dose TSEBT (18 Gy or above) or low-dose TSEBT (12 Gy), and among those with low-dose TSEBT substratified them between standard fractionation (12 fractions) or hypofractionation (6 fractions). We recorded each patient's primary outcomes, which included response to radiation (complete response, near complete response, partial response, stable disease, or progressive disease), time to response, duration of response, and any acute toxicities. Physician-assessed secondary outcomes, demographic information, and any systemic treatments given concurrently or adjuvantly with TSEBT were also included. Results Overall, 46 patients received 59 courses of TSEBT, with 39 patients receiving 52 courses of low-dose TSEBT. Of the 52 low-dose courses evaluated, median age at treatment was 62.5 years old (range, 21-91). Most patients had stage IB, IIB, or IVA disease before initiation of TSEBT. The overall response rate was 87%. Nine courses (17%) resulted in a complete response, 5 courses (9.6%) resulted in a near complete response, and 25 courses (48%) resulted in a partial response. The incidence of progression of skin disease was 17% at 6 months and 21% at 1 year. Of the 59 total courses, 40 patients had hypofractionation (full cycle) and 8 patients had standard fractionation (half cycle). There was no significant difference in the response rate between these two groups. The median time to response for the hypofractionation compared to the standard fractionation was 7 weeks versus 8.5 weeks, respectively, while the duration of response was 46 weeks versus 54 weeks, respectively. Concurrent treatments included bexarotene for 2 patients, brentuximab for 2 patients, interferon for 1 patient, and romidepsin for 1 patient. Importantly, no patients experienced significant toxicities including those in the hypofractionation group, with the exception of 1 patient (2.5%) who experienced grade 3 desquamation. Conclusion In the largest series to date of low-dose TSEBT using a hypofractionation scheme, our results suggest that it is equally safe and effective as traditional fractionation. This novel condensed low-dose TSEBT comes with the added benefits of convenience and cost-effectiveness, as well as decreased patient exposure to the healthcare system during the current pandemic, and should be considered for all CTCL patients needing TSEBT. Moving forward, we look to evaluate the impact of radiation therapy with concurrent or adjuvant treatments for patients with CTCL as alternative options for possibly supplementing the efficacy of radiotherapy and/or reducing the need for recurrent radiation altogether. Disclosures Desai: Boston Scientific: Consultancy, Research Funding.


Blood ◽  
2021 ◽  
Vol 138 (Supplement 1) ◽  
pp. 2446-2446
Author(s):  
Pamela Allen ◽  
Katherine Case ◽  
Tony Zhuang ◽  
Mark Justin Jedrzejczak ◽  
Erica Shantha Tarabadkar ◽  
...  

Abstract Introduction Large cell transformation (LCT) in mycosis fungoides is defined as 25% large cells and is traditionally associated with a poor prognosis and a median survival of 3-5 years. There is no consensus on the appropriate management for these patients. We aimed to characterize clinical and pathologic features of patients with transformed mycosis fungoides (tMF) at our institution and to describe treatment patterns and patient outcomes. Methods We performed a retrospective review of 63 patients with a histopathologic diagnosis of tMF seen at the Winship Cancer Institute of Emory University from 1990-2021. Clinical data collected from the electronic medical record included demographics, baseline laboratory values, disease characteristics, pathologic characteristics, and therapy. Kaplan-Meier curves for OS and PFS were generated for the whole cohort. Descriptive analysis was performed for covariates. The association of baseline variables with OS was modeled by Cox proportional hazards model. Results Among 63 patients with tMF, there was even distribution among male (54%) and female (46%) patients (Figure 1A). The median age at the time of large cell transformation (LCT) was 63 years (range, 20-87). This population included 46% African American (AA), 50.8% White, 1.6% other races (n=1). At the time of diagnosis, the stage was 1A-1B in 23 (36.5%), 2A in 11 (17.5%), 2B in 20 (31.7%), 3A-3B in 3 (4.8%), 4A in 5 (7.9%) and 4B in 1. The ECOG performance status (PS) was 0-1 in 49 (77.8%), 2 in 7 patients (11.1%), 3 in 3 patients, and 4 in one patient. Most patients had patches and plaques at diagnosis, 23 (36.5%) had tumors, and 9 (14.3%) had ulceration. Only 2 patients had hypopigmented MF. The most common therapies prior to LCT were topical steroids (n=34), phototherapy (n=25), topical nitrogen mustard (n=20), oral retinoids (n=14), and oral methotrexate (n=8). Radiation (RT) was received in 22 patients prior to transformation with 16 having localized RT and 9 total skin electron beam therapy (TSEB). The median time from diagnosis to LCT was 2.1 years (range, 0-32 years). Most patients had advanced stage at the time of LCT (n=45, 86%), with stage 2B the most frequent 23 (36.5%). Other stages at LCT were 1A in 1 patient, 2A in 6, 3A-B in 6, 4A in 14 and 4B in 11. Overall, 47 (74.6%) patients experienced progression in their TNMB stage following LCT. LCT occurred in the skin in 51 patients (81%), lymph nodes in 21 (33.3%), and viscera in 5 (7.9%). The percentage of large cells was >50% in 24 patients (38.1%), and < 50% in 13 (20.6%). CD30 percentage was missing in the majority of patients (n=37, 58.7%). T-cell rearrangement in blood, skin, and lymph nodes was not consistently characterized with data missing in nearly half the patients (n=30, 47.6%). In those with TCR checked in at least one location, it was non-clonal in 19, had clonal persistence in 6 (9.5%), clonality in at least one sample but either not rechecked, or not persistent in 6 (9.5%), and oligoclonal in 2 (n=3.2). The most common treated for LCT was total skin electron beam therapy (TSEB, n=16) and chemotherapy (n=14), followed by brentuximab vedotin and localized RT in 9 patients each. Other treatments included topical corticosteroids (N=2), histone deacetylase inhibitors (n=4), and mogamulizumab (n=4). The median overall survival was 2.3 years from LCT (95% CI 1.1-3.5 years), and the median PFS was 2.6 years (95% CI, 1.1-4.1 years) (Figure 1B) . The median time to treatment following LCT was 30 days (range, -1 day to 2.3 years). By cox regression, neither baseline demographic factors, tumor characteristics, treatment, nor time to LCT were associated with progression-free or overall survival. Only response to treatment for LCT (complete response, partial response, or stable disease) was associated with survival (p=0.041, Figure 1C). Conclusions We characterized the clinical features and outcomes of a cohort of patients with tMF seen at Emory University over a 30 year period. We found poor outcomes despite many patients receiving novel and targeted therapies in the modern era. Key pathologic and clinical variables such as CD30 percentage and t-cell gene rearrangement studies were not reported for many patients, suggesting standardized practices are needed in the diagnosis and pathologic evaluation of patients with tMF. Additional pathologic correlatives will be updated at the time of the presentation. Figure 1 Figure 1. Disclosures Allen: ADC Therapeutics: Consultancy; Kyowa Kirin: Consultancy; Secure Bio: Consultancy.


2021 ◽  
Vol 11 (7) ◽  
pp. 333
Author(s):  
Danik Martirosyan ◽  
Masoomeh Shahnazari-Aval ◽  
Mohammad Reza Ashoori ◽  
Afsaneh Seyed Mikaeili ◽  
Manouchehr Nakhjavani ◽  
...  

Background: The main purpose of this study was to investigate whether or not electron beam therapy (EBT) was an effective method in terms of moderating oxidative stress by reducing free radicals in BALB/c mice with type 1 diabetes mellitus.Methods: The study was performed on thirty BALB/c mice in three groups including normal control, diabetic control, and EBT treated. Before studying the effect of electron beam on the studied groups, optimal level of constant source-to-surface distance, as well as the effects of EBT on glutathione reductase (GR) structure and function were determined. After studying the structure and the function of GR protein with three methods including fluorometry, circular dichroism (CD), and activity assay methods, SSD 100 was selected for EBT. Glucose, advanced glycation end-products, GR, oxidative stress factors such as hydrogen peroxide, malondialdehyde, advanced oxidation protein products, oxidized low-density lipoprotein, and inflammatory factors were measured in the serum of all groups.Results: The results of in vitro study showed that electron beam therapy could increase glutathione reductase activity, which was not significant. Also, the results were compared between and within groups using one-way analysis of variance. Significant differences were observed for all variables measured between the normal control group and the other groups (P < 0.05). There was also no significant difference in blood glucose levels between the electron beam therapy treated group and the diabetic one (P > 0.05).Conclusion: The results suggested that electron beam therapy could be effective in reducing free radicals and oxidative stress. Electron beam therapy, as a complementary method, might aid in moderating the complications of diabetes mellitus.Keywords: Diabetes mellitus, Electron beam, Inflammatory factors, Oxidative stress


2021 ◽  
Author(s):  
Blake W. Boudreaux ◽  
Meera H. Patel ◽  
Caitlin M. Brumfiel ◽  
Jake Besch-Stokes ◽  
David J. DiCaudo ◽  
...  

2021 ◽  
pp. 100698
Author(s):  
Bradley G. Ackerson ◽  
Qiuwen Wu ◽  
Oana Craciunescu ◽  
Taofik Oyekunle ◽  
Donna Niedzwiecki ◽  
...  

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