五例皮肤蕈样霉菌病的全身电子线照射随访结果  

Follow-up of 5 patients with mycosis fungoides after total skin electron irradiation

作　　者：孙丽[1] 许康雄[1] 翟振宇[1] 许建华[1] 

机构地区：[1]南京医科大学附属江苏省肿瘤医院放疗科,南京210009

出　　处：《中华放射医学与防护杂志》2013年第4期400-402,共3页Chinese Journal of Radiological Medicine and Protection

摘　　要：目的 报道皮肤蕈样霉菌病的全身电子线照射技术、治疗并发症及近远期疗效.方法 回顾性分析5例皮肤蕈样霉菌病患者的临床资料,并作长期随访.男4例,女1例,中位年龄51岁（14 ～56岁）.4例患者8周接受30 ～31.25 Gy/30次的全身电子线照射,另1例患者之前接受了6个周期化疗,后接受8周全身电子线照射31Gy/31次,残留病灶局部补充电子线剂量至36 Gy.皮肤剂量约为处方剂量的90％,照射野内剂量均匀性控制在处方剂量的±10％以内.结果 放疗后6个月,4例患者疗效评价均为完全缓解,1例为近期治疗,放疗结束时评价为接近完全缓解.急性不良反应可以耐受.2例患者分别于全身电子线治疗后3年和1年死于内脏受累,死亡前皮肤无复发表现,2例患者至随访17年及15年时仍健康存活,1例近期治疗患者放疗结束后2个月仍健康存活.结论 全身电子线照射皮肤蕈样霉菌病局部疗效确切,不良反应可以耐受,脏器侵犯是主要的失败原因.Objective To report the total skin electron irradiation（TSEI） to treat the mycosis fungoides and the related acute toxicity,short-term efficacy and long-term results.Methods Five patients with pathologically confirmed mycosis fungoides were enrolled from 1990 to 2011,including 4 males and 1 female.Median age was 51 years old（range 14-56 years old）.Dose homegeneity within the field were ± 10% of the prescribed dose with a skin surface dose of about 90% of the prescribed dose.Four cases received a total dose of about 30 Gy in 30-32 fractions in 8 weeks,and the other case received an electron boost of 5 Gy to the residual tumor after irradiation with 31 Gy within 31 fractions in 8 weeks,who had received 6 cycles chemotherapy before TSEI.Results 4 cases with a follow-up time of more than 15 years achieved complete response 6 months after radiotherapy.For the recently treated case,a great partial response was achieved after radiotherapy.Acute toxicities for all patients were acceptable.Two patients survived after a follow-up of more than 15 years while the other two cases died of visceral involvement at 1 and 3 years later,respectively.The case treated recently survived 2 months later.Conclusions A total TSEI dose of about 30 Gy within 30-32 fractions during 8 weeks could be proved to be very effective and safe in skin lesion control.Visceral involvement is the main failure type.

关 键 词：皮肤蕈样霉菌病 全身电子线照射 随访 

分 类 号：R7[医药卫生—临床医学]