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Case Report/Case Series |

Palliative Therapy for Recalcitrant Cutaneous T-Cell Lymphoma of the Hands and Feet With Low-Dose, High Dose-Rate Brachytherapy

Allison L. Goddard, MD1,2,3; Ruth Ann Vleugels, MD, MPH1,2; Nicole R. LeBoeuf, MD, MPH1,2,3; Desmond A. O’Farrell, MSc, DABR4; Robert A. Cormack, PhD4; Jorgen L. Hansen, MS4; Thomas S. Kupper, MD1,2,3; Phillip M. Devlin, MD2,3,4
[+] Author Affiliations
1Department of Dermatology, Brigham and Women’s Hospital, Boston, Massachusetts
2Harvard Medical School, Boston, Massachusetts
3Center for Cutaneous Oncology, Dana Farber Cancer Institute, Boston, Massachusetts
4Department of Radiation Oncology, Brigham and Women’s Hospital, Boston, Massachusetts
JAMA Dermatol. 2015;151(12):1354-1357. doi:10.1001/jamadermatol.2015.3028.
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ABSTRACT

Importance  Cutaneous T-cell lymphoma (CTCL) of the hands and feet can be challenging to treat and cause significant disability for patients. Although CTCL is a highly radiosensitive tumor, the complex topography of acral surfaces presents challenges to achieving homogeneous superficial dosing of traditional electron beam therapy. In addition, traditional dosing may result in substantial acute cutaneous toxic effects. Recent reports demonstrate that low-dose palliative radiotherapy may be as effective as traditional regimens in CTCL. High dose-rate (HDR) brachytherapy allows for control of the depth of radiation penetration over complex curved surfaces. This study investigated the role of low-dose HDR brachytherapy for acral CTCL lesions.

Observations  Six patients with a total of 8 acral CTCL lesions received low-dose HDR brachytherapy during a 3-year period. Rapid improvement and clinical clearance were observed in all treated lesions with minimal to no acute cutaneous toxic effects. During a mean follow-up period of 15.8 months, 1 lesion recurred locally; the remaining 7 lesions had sustained clinical remission. No long-term sequelae were observed.

Conclusions and Relevance  This case series demonstrates that low-dose HDR brachytherapy provides excellent palliation for local control of acral CTCL lesions, offering homogeneous, controlled dosing for complex topographic sites with minimal to no cutaneous toxic effects.

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Figure 1.
Brachytherapy Treatment Planning Computed Tomography

Curved isodose lines outlining the homogeneous and superficial radiation dose to be delivered along this curved surface.

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Figure 2.
Clinical Photographs of Mycosis Fungoides Lesion

A, Lesion of mycosis fungoides over the complex and curved surface of the foot. B, Eight weeks after the end of treatment, the lesion has clinically resolved, and no erythema, induration, or scale is visible.

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