Cem Onal1,2, Ezgi Oymak3, Mehmet Reyhan4, Tuba Canpolat5, Ozgur Ozyilkan6. 1. Department of Radiation Oncology, Baskent University Faculty of Medicine, Adana, Turkey. hcemonal@hotmail.com. 2. Adana Research and Treatment Centre, Department of Radiation Oncology, Baskent University Faculty of Medicine, 01120, Adana, Turkey. hcemonal@hotmail.com. 3. Department of Radiation Oncology, Baskent University Faculty of Medicine, Adana, Turkey. 4. Department of Nuclear Medicine, Baskent University Faculty of Medicine, Ankara, Turkey. 5. Department of Pathology, Baskent University Faculty of Medicine, Ankara, Turkey. 6. Division of Medical Oncology, Baskent University Faculty of Medicine, Ankara, Turkey.
Abstract
INTRODUCTION: Langerhans' cell histiocytosis (LCH) is a proliferative disorder of Langerhans cells, which is seen extremely rarely in adults. Conventional imaging modalities, such as skeletal surveys and bone scans, were accepted to be standard methods for diagnosis; however, 18-fluorodeoxyglucose positron emission tomography (PET-CT) has been increasingly used. METHODS: We report on a 33-year-old female patient with disseminated LCH treated with radiotherapy and systemic chemotherapy where PET-CT has been used for defining the extent of the disease, RT planning and assessment of treatment response during follow-up. RESULTS: The patient was treated with 24 Gy 3-dimensional conformal radiotherapy (RT), given as 2 Gy a day, 5 days a week. The patient was also treated with systemic prednisolone 20 mg/m(2), concurrently. The chemotherapeutic regimen switched to cytosine-arabinoside with a dose of 100 mg/m(2) subcutaneously daily for 4 days, vincristine 1.5 mg/m(2) given on the 1st day and prednisolone 20 mg/m(2) for 4 cycles. After local RT with adjuvant chemotherapy, the patient was alive for 54 months and remained disease-free at last visit. CONCLUSION: RT is a treatment choice in multi-system LCH as well as solitary lesions. Low-dose RT is adequate to control large masses of LCH including soft tissue and lymph nodes.
INTRODUCTION: Langerhans' cell histiocytosis (LCH) is a proliferative disorder of Langerhans cells, which is seen extremely rarely in adults. Conventional imaging modalities, such as skeletal surveys and bone scans, were accepted to be standard methods for diagnosis; however, 18-fluorodeoxyglucose positron emission tomography (PET-CT) has been increasingly used. METHODS: We report on a 33-year-old female patient with disseminated LCH treated with radiotherapy and systemic chemotherapy where PET-CT has been used for defining the extent of the disease, RT planning and assessment of treatment response during follow-up. RESULTS: The patient was treated with 24 Gy 3-dimensional conformal radiotherapy (RT), given as 2 Gy a day, 5 days a week. The patient was also treated with systemic prednisolone 20 mg/m(2), concurrently. The chemotherapeutic regimen switched to cytosine-arabinoside with a dose of 100 mg/m(2) subcutaneously daily for 4 days, vincristine 1.5 mg/m(2) given on the 1st day and prednisolone 20 mg/m(2) for 4 cycles. After local RT with adjuvant chemotherapy, the patient was alive for 54 months and remained disease-free at last visit. CONCLUSION: RT is a treatment choice in multi-system LCH as well as solitary lesions. Low-dose RT is adequate to control large masses of LCH including soft tissue and lymph nodes.
Authors: C L Willman; L Busque; B B Griffith; B E Favara; K L McClain; M H Duncan; D G Gilliland Journal: N Engl J Med Date: 1994-07-21 Impact factor: 91.245