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Radiotherapy for extramedullary leukaemic manifestation (Chloroma)

Strahlentherapie bei extramedullärer leukämischer Manifestation (Chlorom)

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Abstract

Purpose

Extramedullary leukaemic disease (EMD, synonym chloroma) is a rare solid manifestation of myeloid leukaemia for which the value of radiotherapy (RT) as a treatment strategy remains controversial. The aim of this study is to analyse the effectiveness of various RT doses for EMD in the modern treatment era.

Materials and methods

Between January 2000 and June 2016, 20 patients with total of 45 lesions underwent RT for EMD at our institution.

Results

With a median radiation dose of 26 Gy (range 4–42 Gy), local remission could be achieved in 91% of patients (complete remission rate: 71%). The median duration of local control (DOLC) was 17 months (95% confidence interval [CI] 0.5–33) and the median overall survival (OS) after chloroma onset was 24 months (95% CI 11–38). No noticeable difference between high- and low-dose regimens has been observed (74% versus 68%; P = 0.5). In the multivariate analysis, only Eastern Cooperative Oncology Group (ECOG) score and bone marrow state during RT have proven to be determinant for durable local control and OS.

Conclusions

Low-dose RT (≤26 Gy) achieves good local control compared to high-dose regimes. Bone marrow state during RT and ECOG score during RT may play a crucial role, influencing both DOLC and OS.

Zusammenfassung

Zielsetzung

Extramedulläre leukämische Infiltrate (EMD) sind seltene Manifestationen myeloischer Leukämien, in deren Behandlungskonzepten der Stellenwert der Radiotherapie (RT) unklar ist. Das Ziel der vorgelegten Studie ist es, die Wirksamkeit verschiedener Strahlentherapiedosen für EMD in der modernen Behandlungsära zu untersuchen.

Material und Methoden

Zwischen Januar 2000 und Juni 2016 durchliefen 20 Patienten mit insgesamt 45 Läsionen eine RT für EMD in unserer Klinik.

Ergebnisse

Mit einer mittleren RT-Dosis von 26 Gy (Spanne 4–42 Gy) konnte eine lokale Remission bei 91 % der Patienten erzielt werden (komplette Remissionsrate, CRR: 71 %). Die mittlere Dauer der Lokalkontrolle (DOLC) betrug 17 Monate (95 %-KI 0,5–33) und das mediane Gesamtüberleben (OS) nach Chloromadiagnose war 24 Monate (95 %-KI 11–38). Es fand sich kein wesentlicher Unterschied zwischen Niedrig- und Hochdosis-RT (74 % versus 68 %; P = 0,5). Läsionen mit einer günstigen Prognose nach zytogenetischen und molekulargenetischen Faktoren sowie Läsionen, die mit einer modernen Strahlentherapietechnik wie intensitätsmodulierter Radiotherapie (IMRT) behandelt wurden, erreichten eine CRR von 100 % (P = 0,05 bzw. P = 0,008). In der multivariaten Analyse zeigten sich der ECOG-Score (Eastern Cooperative Oncology Group) und eine Remission im Knochenmark als entscheidend für die lokale Kontrolle, während der ECOG-Score, die Bestrahlungstechnik und das Ansprechen auf die RT das OS beeinflussten.

Schlussfolgerungen

Niedrigdosis-RT (≤26 Gy) erzielt eine ebenso gute lokale Kontrolle wie Behandlungskonzepte mit höherer Dosis. Der ECOG-Score vor der RT scheint eine zentrale Rolle für OS und DOLC zu spielen.

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Authors and Affiliations

  1. Department of Radiation Oncology, University Hospital of Muenster, Albert-Schweitzer-Campus 1, Building A1, 48149, Muenster, Germany

    Michael Oertel MD, Khaled Elsayad MD,  Uwe Haverkamp PhD &  Hans Theodor Eich MD

  2. Department of Internal Medicine, University Hospital of Muenster, Albert-Schweitzer-Campus 1, Building A1, 48149, Muenster, Germany

    Matthias Stelljes MD

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  1. Michael Oertel MD
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Correspondence to Khaled Elsayad MD.

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Conflict of interest

M. Oertel, K. Elsayad, U. Haverkamp, M. Stelljes and H.T. Eich declare that they have no competing interests.

Ethical standards

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Additional information

M. Oertel and K. Elsayad contributed equally to this work.

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Oertel, M., Elsayad, K., Haverkamp, U. et al. Radiotherapy for extramedullary leukaemic manifestation (Chloroma). Strahlenther Onkol 194, 164–173 (2018). https://doi.org/10.1007/s00066-017-1236-4

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