Moderate-Dose Local Radiotherapy in Symptomatic CD30-Positive, Anaplastic Lymphoma Kinase (ALK)-Negative Primary...

Primary cutaneous anaplastic CD30-positive (+) T-cell lymphoma is a rare variant of primary cutaneous lymphoma characterized by proliferation of large T lymphocytes with strong CD30 expression and no anaplastic lymphoma kinase (ALK) expression. It typically presents as rapidly growing nodules or tumors with a tendency to ulcerate, but often has a favorable outcome in localized stages. Radiotherapy is an effective local treatment for cutaneous T-cell lymphomas, and several retrospective studies suggest that low-dose regimens may achieve high response rates with reduced toxicity, although prospective randomized data are lacking. We describe the case of a 65-year-old female patient who initially presented with generalized erythematous patches and plaques that progressed to painful nodules and later ulcerated. Biopsy confirmed a CD30+, ALK-negative, T-cell lymphoma. The patient received chemotherapy with the CHOEP regimen and, during the sixth cycle, developed a new ulcerated lesion on her right thigh accompanied by local signs of infection, leukocytosis, and fever. The patient was then started on antibiotics with no improvement. Localized radiotherapy was then administered, which resulted in progressive improvement of the lesion from the first sessions, with tumor volume reduction, decreased exudate, and partial re-epithelialization of the ulcerated bed. This case highlights the role of localized radiotherapy as an effective palliative and disease-controlling modality for cutaneous CD30+ T-cell lymphoma, particularly in symptomatic or treatment-refractory lesions.