ABSTRACT
BACKGROUND: Total lymphoid irradiation (TLI) has been used as an effective therapy for refractory allograft cardiac transplantation rejection. In this study we assessed our short-course TLI regimen for treatment of this condition. METHODS: A short course of TLI (4.5 Gy in 4 fractions) was given to 6 patients with recalcitrant allograft cardiac transplant rejection at the Royal Perth Hospital. RESULTS: Treatment compliance was excellent with most patients having no acute toxicity. With a median follow-up of 25 months, 83% of patients remain alive and disease-free. CONCLUSIONS: To date, no convincing evidence of radiation-related late effects have been documented with TLI. Nonetheless, larger scale trials are required for validation before this approach can be widely incorporated into the current transplantation (Tx) rejection regimen.
Subject(s)
Graft Rejection/radiotherapy , Heart Transplantation/adverse effects , Lymphatic Irradiation/methods , Adult , Costs and Cost Analysis , Dose-Response Relationship, Radiation , Endpoint Determination , Female , Graft Rejection/immunology , Heart Transplantation/immunology , Humans , Immunosuppressive Agents/therapeutic use , Incidence , Lymphatic Irradiation/adverse effects , Lymphatic Irradiation/economics , Male , Middle Aged , Survival AnalysisABSTRACT
Western Australia has only two superficial radiotherapy units, one of which is located at Fremantle Hospital, and run by the radiation oncologists of Perth Radiation Oncology Centre. A 3-year retrospective review was undertaken of all patients who underwent treatment at this unit from 1999 to 2001. Patients were identified from the unit's log book, and data was collected from their files. For malignant skin conditions, 369 lesions were treated in 259 patients over the study period. The patients' median age was 76 years. A wide variety of conditions were treated, but the most common diagnoses were basal cell carcinoma (237 lesions) and squamous cell carcinoma (92 lesions), most commonly located in the head region. The most frequently used treatment schedule was 36 Gy in six fractions over a 3-week period. Where radiotherapy was administered as primary treatment, the diagnoses had been biopsy-proven in only 53% of cases. Fifty-four patients underwent treatment of benign skin disease over the study period; most commonly keloid scars (41 patients) followed by warts (six patients). We conclude that superficial radiotherapy has a distinct role in dermatology, particularly for skin carcinomas around the nose and eyes, which cannot presently be superseded by electron beam therapy.
