Absence of Koebnerization Following Ablative and Nonablative Laser Therapy in Patients With Plaque Psoriasis.

BACKGROUND: The adverse effects of laser procedures performed in patients with psoriasis have not been reported to date. OBJECTIVE: The authors report the incidence of koebnerization in patients with psoriasis who underwent laser treatment with different devices over the past 12 years. MATERIALS AND METHODS: The medical records of 38 patients with psoriasis treated with laser therapy were reviewed. Patient characteristics, including duration and severity of psoriasis, baseline psoriasis treatment, laser modality and settings, facial areas treated, and number of sessions, were collected. The primary outcome of interest was incidence of koebnerization. RESULTS: None of the 38 patients with psoriasis treated with laser therapy experienced subsequent koebnerization. Seven patients were on oral systemic medications, 14 were on biologic agents, and 3 were on combination therapy. None of the patients experienced skin infections, delayed healing, or scarring, irrespective of their psoriasis therapy. CONCLUSION: Koebnerization did not occur on the face, neck, or scalp of patients with psoriasis who underwent laser therapy, irrespective of psoriasis severity or types of psoriasis medications they were receiving. Although these results are encouraging, the risk of koebnerization should be discussed with patients with psoriasis who wish to undergo laser procedures.

First Reported Case of Postirradiation Pseudosclerodermatous Panniculitis After Stereotactic Body Radiation Therapy for the Treatment of Non-Small Cell Lung Cancer.

Postirradiation pseudosclerodermatous panniculitis is a rare complication of radiation therapy that presents as an indurated plaque and/or subcutaneous nodule in an area of previously irradiated tissue. The histopathologic pattern is of mixed lobular and septal panniculitis with necrotic adipocytes and thickened sclerotic septa as well as dense inflammatory infiltrates consisting mainly of histiocytes. The typical time interval is 1 month to several years after treatment with radiation therapy. This is a case of an 86-year-old man with a medical history significant for diffuse large B-cell lymphoma who was given 3 fractions of stereotactic body radiation therapy for treatment of stage IA non-small cell lung adenocarcinoma of the right upper lobe. Two years later, he presented with several small palpable subcutaneous right axillary nodules, which coalesced into a 6-cm firm multilobulated right axillary mass over several weeks. Histopathology showed sclerosing panniculitis with lipomembranous changes and septal fibrosis. This is the first reported case describing postirradiation pseudosclerodermatous panniculitis in a patient with lung cancer treated with stereotactic body radiation therapy. This diagnosis must be differentiated from other subtypes of panniculitis and complications of radiation therapy.

Proton therapy in the management of non-Hodgkin lymphoma.

Proton therapy (PT) is a highly conformal type of radiation therapy that can target the tumor while sparing dose to surrounding normal tissues. This study reviews a single institution's experience managing patients with non-Hodgkin lymphoma (NHL) treated with PT. Eleven patients with NHL were treated with PT from January 2008 to January 2014 on an institutional review board-approved outcomes tracking protocol, and included patients with indolent orbital lymphoma (n = 4), primary mediastinal B-cell lymphoma (n = 3), plasmablastic lymphoma (n = 2) and natural killer (NK) T-cell lymphoma (n = 2). The median follow-up was 38 months. The 2-year rate of local control was 91%, with one patient with NK T-cell lymphoma having recurrence in-field. Toxicities were limited to grade 2 at highest, during follow-up. PT is a feasible and effective treatment for NHL. Early outcomes are favorable. Longer follow-up and more patients are needed to confirm our findings.

Proton therapy to the subdiaphragmatic region in the management of patients with Hodgkin lymphoma.

Twelve consecutive patients with classical Hodgkin lymphoma (HL) involving diaphragmatic or subdiaphragmatic regions were treated on an institutional review board-approved outcomes tracking protocol. All patients underwent treatment with proton therapy following chemotherapy and had comparative three-dimensional conformal photon radiotherapy (3DCRT) and intensity-modulated radiotherapy (IMRT) plans to evaluate differences in dose to organs at risk (OARs). Among the cohort, stomach doses with 3DCRT, IMRT and proton therapy were 21 Gy (median), 14 Gy and 6 Gy, respectively. Median dose reductions with proton therapy compared with 3DCRT and IMRT were 13 Gy (p = 0.0022) and 8 Gy (p = 0.0022) for the stomach. Additionally, there was significant dose reduction using proton therapy for the liver, pancreas, bowel, left kidney and right kidney. Proton therapy reduces the dose to the stomach, liver, pancreas, small bowel and kidneys compared with 3DCRT or IMRT in patients with HL requiring abdominal radiotherapy. These dose reductions are expected to translate into lower risks of secondary cancers and other late toxicities in survivors of HL.

Use of AlloDerm implant to improve cosmesis after parotidectomy.

We evaluated the effectiveness and practicality of using AlloDerm, an acellular human dermal matrix graft, as an interpositional barrier in an attempt to improve the appearance of the surgical defect created by parotidectomy. We performed AlloDerm reconstruction in a series of 10 patients, and we found that normal contour was satisfactorily restored in all 10. We conclude that the use of an AlloDerm implant is a low-risk, practical option for repairing the surgical defect in postparotidectomy patients.

Immune signatures of murine and human cancers reveal unique mechanisms of tumor escape and new targets for cancer immunotherapy.

PURPOSE: Despite lymphocyte infiltration of tumors and the activation of tumor-draining lymph nodes, malignant tumors are able to "escape" from both innate and adaptive immune responses. For immunotherapy to be successful, it must reverse these escape mechanisms, which necessitates explicit and tumor-specific elucidation of tumor escape strategies. RESEARCH DESIGN: To identify relevant escape mechanisms in murine tumors and in two corresponding human cancers, real-time reverse transcription-PCR was used to measure a panel of genes associated with T-cell activation and inhibition pathways. RESULTS: Comparative analysis of the expression levels of these immunomodulatory genes showed astonishing similarities in expression patterns between murine and human breast cancers but profound variability in the expression of immunomodulatory genes in colorectal cancers. For human ductal adenocarcinoma of the breast, down-regulation of dendritic cell maturation marker CD83 and T-cell activation gene CD28 was observed as well as a notable increase in the expression of the immunoinhibitory gene B7-H4. By contrast, colorectal adenocarcinoma cases showed high variability in tumor escape mechanisms, indicating a need to produce immune signatures for individual patients to identify appropriate immunotherapeutic targets. CONCLUSIONS: These results show that certain tumors, such as ductal carcinoma of the breast, show consistent immunologic abnormalities that can be used as targets for immunotherapy. These findings also show the importance and feasibility of determining the immune signatures of patients' tumors to select appropriate immunotherapeutic strategies. Ultimately, these results advocate for the determination of immune signatures as part of the customary repertoire of clinical diagnostics for cancer.

Targeted and untargeted CD137L fusion proteins for the immunotherapy of experimental solid tumors.

INTRODUCTION: CD137L is a member of the tumor necrosis factor superfamily that provides a costimulatory signal to T cells. In this study, two novel CD137L fusion proteins were produced and compared with the CD137 agonist antibody 2A. MATERIALS AND METHODS: Murine CD137L was linked to the COOH terminus of either the Fc fragment of immunoglobulin (untargeted version) or TNT-3 (targeted version), an antibody that binds to necrotic regions of tumors. Groups of mice bearing established Colon 26 tumors were then treated daily x 5 with each fusion protein or 2A to determine their immunotherapeutic potential. RESULTS: Both fusion proteins retained CD137L activity in vitro and TNT-3/CD137L showed tumor-binding activity by biodistribution analysis in tumor-bearing mice. The fusion proteins also produced similar responses in vivo at the 1 nmol per dose range and showed a 60% (TNT-3/CD137L) or 40% (Fc/CD137L) survival of treated mice at 150 days after tumor implantation, similar to the effects of 2A. Morphologic and immunohistochemical analyses showed massive central necrosis and infiltration of granzyme B-positive cells in necrotic areas and viable peripheral regions of treated tumors. Finally, cell depletion studies showed that CD137L-mediated tumor regression was CD8(+) T cell dependent. CONCLUSIONS: From these studies, it was determined that both targeted and untargeted CD137L fusion proteins showed effective antitumor activity, but that the targeted version was more potent. Therefore, the use of the natural CD137 ligand is a promising approach to the treatment of solid tumors by virtue of its ability to produce physiologic costimulation within the tumor, limiting side effects often seen with agonist antibody therapies.