30 hours ago Leukemia cutis, a form of extramedullary leukemia involving the skin, is a poor prognostic marker and indicator of imminent hematologic relapse and chemotherapeutic resistance in leukemia patients. Although total skin electron beam radiotherapy is commonly recommended for patients with leukemia cutis, its role and effectiveness remains unclear. >> Go To The Portal
The role of radiation therapy for those with leukemia cutis, particularly pediatric patients, remains unclear. This report describes the first two cases of disseminated leukemia cutis in adolescents treated with total skin electron beam therapy. Both patients had resolution of their skin disease and significant palliation of symptoms.
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A literature review was undertaken to identify current TSEB therapy in pediatric patients.
The idea of total skin electron beam (TSEB) therapy is to deliver a prescribed dose only to the patient's skin and to protect as much as possible healthy tissues inside the body.
To the best of my knowledge, only seven pediatric patients treated with TSEB have been reported in the literature. Most of them were infants (median age 14 months, range 12–17 months) and two patients were 13 and 18 years old. Among this group, there were three males and two females. The sex of two patients was not reported.
TSEB therapy has a long history in treating skin diseases. There are three main techniques of TSEB irradiation that have been well described in the literature. 29, 30 Apart from them, there are many modified techniques that are combinations of the above mentioned ones.
TSEB therapy for children was planned mostly with 6 MeV; however, Rubin et al. 21 used 8 MeV degraded electron fields. The prescription doses varied from 16 Gy to 28 Gy. The irradiation schedule differed across radiotherapy centers and patient conditions ( Table 1 ).
During TSEB therapy for children, some parts of the body should be shielded. This applies mostly to finger tips and toes since those areas are very thin and can experience much higher dose than the rest of the skin. Another organ that may be shielded during TSEB therapy are lenses since they are very sensitive to radiation dose.
TSEB therapy for children can be administered without problems to adolescents as described by Pepek et al., 23 because the patient can stand on their own and cooperate with the radiotherapy staff. The problem begins when a very young pediatric patient has to be irradiated. The most difficult part was to set up an infant for the time of treatment.
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This article contains Supplementary Material available at http://www.interscience.wiley.com/jpages/1545‐5009/suppmat .