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Radiotherapy of cutaneous B cell lymphomas: Our experience in 31 cases

PURPOSE Since cutaneous B cell lymphomas belong mostly to low or intermediate histologic grade of malignancy and have low tendency to spreading, a local treatment such as radiotherapy appears to be a suitable choice in the management of the disease. The authors have reviewed their cases to verify this statement. METHODS AND MATERIALS 31 patients affected by cutaneous B cell lymphomas classified as IE stage according to Ann Arbor received radiotherapy with orthovoltage techniques with total doses per field ranging from 10 to 40 Gy (median dose 30 Gy). All the patients had a minimum follow-up of 2 years. RESULTS All the target skin lesions underwent complete remission. In 10 patients (32.2%) the clinical remission is still lasting. In 21 cases (67.8%) a disease relapse was observed: only at skin in other sites than those previously treated in 17 (81%), at skin and lymph nodes in two cases (9.5%), at skin, bone, and lymph node in one case (4.7%), at skin and bowel in one case (4.7%). The extracutaneous involvement occurred in cases with lesions of intermediate grade malignancy. After a new course of radiotherapy for skin lesions only, and chemotherapy, surgery or megavoltage radiotherapy for the other involvements, on the whole 21 patients (67.8%) got a complete remission. CONCLUSION On the basis of their results and of a review of the literature, the authors propose radiotherapy as the choice treatment of primary cutaneous B cell lymphomas.

Photoprotective activity of oral polypodium leucotomos extract in 25 patients with idiopathic photodermatoses

Background: The incidences of idiopathic photodermatoses (IP) are increasing and the available therapeutic methods are often inadequate.

Radiotherapy of skin carcinomas of the pinna: a study of 115 lesions in 108 patients

Background  The possibility of treating skin carcinomas of the pinna with radiotherapy is somewhat under discussion and scarcely known. Therefore the aim of the study was to evaluate the effectiveness and safety of dermatologic radiotherapy in a series of patients affected by basal or squamous cell carcinoma of the pinna.

Radiation therapy of keratoacanthomas: results in 55 patients.

The radiation therapy of keratoacanthomas in fifty-five patients treated between 1976 and 1986 using orthovoltage X rays (contact and soft X ray therapy) is reported. The total dose delivered was 40 Gy by means of twice weekly fractions of 4 Gy each in 52 cases, and 60 Gy by twice weekly fractions of 5 Gy each in 3 cases with notable cellular atypia. In all cases we obtained complete regression of the lesions irradiated within 1 month after the termination of radiotherapy. So far we have not had any recurrences. The cosmetic result was always satisfactory. We should like to point out the association between keratoacanthomas and a second malignancy in two cases. The role of radiotherapy in the treatment of keratoacanthomas is discussed and re-confirmed, in relation to the literature data.

Role of radiotherapy in the treatment of epidemic Kaposi's sarcoma: Experience with sixty-five cases

BACKGROUND Treatment of Kaposis sarcoma (KS) associated with HIV infection should improve often disfiguring lesions, with an acceptable cosmetic outcome; relieve associated signs and symptoms (pain and edema); and have no adverse effects on the patients already impaired immune status. OBJECTIVE Our purpose was to determine the role of x-ray therapy in the treatment of KS. METHODS Contact x-ray therapy and half-deep x-ray therapy were used to treat 594 lesions in 65 patients with KS, who were observed for 1 to 43 months (mean, 9 months). RESULTS Complete remission was achieved with pigmentation in 405 lesions (68.3%), with good cosmetic results in 105 (17.7%), and with hypopigmentation in three (0.5%). In 80 lesions (13.5%) only size reduction or pain palliation were achieved. Fourteen lesions (2.4%) relapsed 2 to 9 months after treatment. CONCLUSION X-ray therapy is well tolerated and meets the specified requirements for the treatment of KS.

Concurrence of vitiligo and psoriasis : a simple coincidence?

1 Marotta PJ, Reynolds RPE. Metastatic Crohn s disease. Am J Gastroenterol 1996; 91: 373–5. 2 Hoque SR, Mortimer P, Cliff S. Penile and scrotal swelling in a child. Clin Exp Dermatol 2005; 30: 727–8. 3 Murphy MJ, Kogan B, Carlson JA. Granulomatous lymphangitis of the scrotum and penis. J Cutan Pathol 2001; 28: 419–24. 4 Porter W, Dinneen M, Bunker C. Chronic penile lymphedema. a report of 6 cases. Arch Dermatol 2001; 137: 1108–10. 5 Bunker CB. Male Genital Skin Disease. London: Elsevier Saunders, 2004; 230–1.

Minimal stage IA mycosis fungoides. Results of radiotherapy in 15 patients

Background: Mycosis fungoides (MF) minimal disease stage IA, characterized by one or few close lesions (up to four), has been considered a distinct entity with a favourable prognosis, where local treatment such as radiotherapy could afford long-lasting remissions. Objective: To review our experience in radiologic treatment of this subset of the disease and compare our results with those reported in the literature. Methods: Fifteen patients presenting with MF minimal disease were treated with localized superficial X-ray therapy, with a total median dose of 22 Gy. Results: At 1 month from the end of radiotherapy, complete remission was observed in 95.45% of irradiation fields and partial remission in 4.54%. The 5-year local progression-free rate was 93.75%, while the overall relapse-free rate at 5 and 10 years was 51%. Conclusions: After an excellent response to radiotherapy, MF minimal disease may experience local or distant failures, even after years. The identification of an optimal dose of radiation and the collection of more cases would be useful in giving new guidelines in the treatment of this subset of the disease.

Intracavitary contact X-ray therapy of oral HIV-associated Kaposi's sarcoma:

A retrospective study was performed to assess the efficacy and low mucosal toxicity of intracavitary contact X-ray therapy (ICRT), a proposed treatment of small/medium sized lesions of oral HIV-associated Kaposis sarcoma (HIV-KS). Twenty-six patients with histologically confirmed oral HIV-KS underwent ICRT in the period 1986-1995. No patient received antiblastic or interferon therapy during the radiotherapy or follow-up periods. ICRT was performed according to the usual technical modalities of contact X-ray therapy, but the end of the source of ionizing radiations was introduced into the oral cavity. The total doses administered ranged from 10 to 50 Gy per field, in one or two weekly fractions of 5 Gy each. The follow-up ranged from 1 to 44 months (mean 7.5 months). Complete remission was obtained in 20 cases (76.92%), partial remission in 6 (23.08%) and relapse in one case (3.84%). Pain was relieved in all cases. Mucosal reaction was mild and did not result in any interruption of treatment. Our data suggest that ICRT is an effective and well tolerated treatment. It can be used in the management of oral HIV-KS instead of external radiotherapy, provided that the size and the location of the lesions and the conformation of the palate are suitable to this technique.

An unusual congenital nail dystrophy (‘soft nail disease’)

An unusual, congenital, non‐familial anomaly of all finger and toe nails was observed in a 33‐year‐old woman. The presence of an atrophic nail plate, which was very soft, has led us to call this condition ‘soft nail disease’. Histological and histochemical investigations have shown this to be an anatomical and functional defect of the nail matrix which is of unknown origin.

Treatment of Skin Carcinomas and Keratoacanthoma

Primary malignant epithelial neoplasms off the skin (PMENs) appear to be constantly on the rise. Radiotherapy has been employed successfully in the therapy of PMENs for a long time and today is based on very effective and safe methods, because of the technological efficiency of the instruments and better radiobiological know-how. The indications and contraindications, suggested by clinical experience, for the choice of radiotherapy in the treatment of PMENs are reviewed. The principles for the selection of radiation quality, a fundamental factor on which the outcome of the treatment may depend, are listed and discussed. Based on modern knowledge, the questions of radiation dose and dose fractionation are considered. The devices that permit the greatest possible accuracy of targeting and safety are described. On the basis of personal experience and literature data, the results obtained are reported and evaluated (5-year cure rates from the end of radiotherapy ranging from 80% to 99%, according to the site and the size of the treated PMENs). The results, acute side effects, and potential long-term damage of the treatment of PMENs are reviewed, particularly in relation to the sites and the clinical conditions where radiotherapy is most frequently indicated (nose, eyelids, lips, recurrent and residual PMENs). The results obtained in the radiotherapy of Bowen’s disease and erythroplasia of Queyrat are also reported. Finally, the role of radiotherapy in the treatment of keratoacanthoma is discussed, with cure rates ranging from 97% to 100% at 5 years from the end of the treatment.