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BioMed Research International
Volume 2013 (2013), Article ID 717589, 11 pages
http://dx.doi.org/10.1155/2013/717589
Research Article

Helical Irradiation of the Total Skin with Dose Painting to Replace Total Skin Electron Beam Therapy for Therapy-Refractory Cutaneous CD4+ T-Cell Lymphoma

1Division of Radiation Oncology, Department of Radiology, Far Eastern Memorial Hospital, No. 21, Section 2, Nanya S. Road, Banciao District, New Taipei City 220, Taiwan
2Department of Medicine, School of Medicine, National Yang-Ming University, Taipei 112, Taiwan
3Institute of Traditional Medicine, School of Medicine, National Yang-Ming University, Taipei 112, Taiwan
4Department of Radiation Oncology, Tri-Service General Hospital, National Defense Medical Center, Taipei 114, Taiwan
5Department of Hematology, Far Eastern Memorial Hospital, New Taipei City 220, Taiwan
6Department of Anatomical Pathology, Far Eastern Memorial Hospital, New Taipei City 220, Taiwan
7Department of Radiation Oncology, Mackay Memorial Hospital, Taipei 104, Taiwan
8Department of Dermatology, Mackay Memorial Hospital, Taipei 104, Taiwan
9Department of Surgical Pathology, Mackay Memorial Hospital, Taipei 104, Taiwan

Received 1 June 2013; Accepted 31 July 2013

Academic Editor: An Liu

Copyright © 2013 Chen-Hsi Hsieh et al. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

A 36-year-old woman was diagnosed with a therapy-refractory cutaneous CD4+ T-cell lymphoma, T3N0M0B0, and stage IIB. Helical irradiation of the total skin (HITS) and dose painting techniques, with 30 Gy in 40 fractions interrupted at 20 fractions with one week resting, 4 times per week were prescribed. The diving suit was dressed whole body to increase the superficial dose and using central core complete block (CCCB) technique for reducing the internal organ dose. The mean doses of critical organs of head, chest, and abdomen were 2.1 to 29.9 Gy, 2.9 to 8.1 Gy, and 3.6 to 15.7 Gy, respectively. The mean dose of lesions was 84.0 cGy. The dosage of left side pretreated area was decreased 57%. The tumor regressed progressively without further noduloplaques. During the HITS procedure, most toxicity was grade I except leukocytopenia with grade 3. No epitheliolysis, phlyctenules, tumor lysis syndrome, fever, vomiting, dyspnea, edema of the extremities, or diarrhea occurred during the treatment. HITS with dose painting techniques provides precise dosage delivery with impressive results, sparing critical organs, and offering limited transient and chronic sequelae for previously locally irradiated, therapy-refractory cutaneous T-cell lymphoma.