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Multifocal soft tissue Langerhans' cell histiocytosis treated with PET-CT based conformal radiotherapy
Cem Onal1,2, Ezgi Oymak3, Mehmet Reyhan4
1Department of Radiation Oncology, Baskent University Faculty of Medicine, Adana, Turkey. hcemonal@hotmail.com.
Insights
Radiotherapy (RT) and chemotherapy effectively treated disseminated Langerhans' cell histiocytosis (LCH) in an adult patient. This approach led to long-term disease remission, highlighting RT as a viable option for LCH management.
Area of Science:
- Oncology
- Radiotherapy
- Histiocytosis
Background:
- Langerhans' cell histiocytosis (LCH) is a rare adult proliferative disorder.
- Conventional imaging is standard, but 18-fluorodeoxyglucose positron emission tomography (PET-CT) is increasingly utilized.
- This case explores LCH management in an adult patient.
Observation:
- A 33-year-old female presented with disseminated LCH.
- PET-CT was used for disease extent, radiotherapy (RT) planning, and treatment response assessment.
- The patient received 24 Gy 3D conformal RT and systemic chemotherapy.
Findings:
- The treatment regimen included concurrent prednisolone and subsequent cycles of cytosine-arabinoside, vincristine, and prednisolone.
- The patient achieved a disease-free status for 54 months post-treatment.
- Low-dose RT proved adequate for controlling LCH masses, including soft tissue and lymph nodes.
Implications:
- Radiotherapy is a suitable treatment option for both multi-system and solitary LCH lesions.
- This case demonstrates the efficacy of combined RT and chemotherapy in adult LCH.
- PET-CT plays a crucial role in LCH diagnosis, treatment planning, and monitoring.
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.
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