VULVAR PAGE'S DISEASE TREATED WITH IMIQUIMOD 5% CREAM AFTER RADIOTHERAPY INTERRUPTED BY RADIATION DERMATITIS

外陰部佩吉特氏症於放射治療中止後以Imiquimod乳膏治療

王聿農(Yu-Nong Wang) ； 李懌鑫(Yi-Hsin Lee) ； 黃經民(Jing-Min Hwang)

《放射治療與腫瘤學》 25卷1期 (2018/03) Pp. 59-63

https://doi.org/10.6316/TRO/201825(1)59

摘要

Extramammary Paget's disease (PD) is a rare intraepithelial adenocarcinoma, which is most commonly seen in areas rich in apocrine glands. About 60% of extramammary PD were observed in the vulva. Vulvar PD accounts for 1% of vulvar cancers. A 95 years old female patient suffered from erythema, crusting, and increased maceration over the vulvar area for more than two years. A nodule about 1 cm in diameter had also been noted at the time she visited the dermatology department at our hospital. The biopsy showed the tumor cells are positive for CK7, which is supportive for Paget’s disease. In consideration of her old age and poor family support, surgical resection is not feasible. She was referred to the radiation oncology department for radiotherapy. The initial treatment plan was to irradiate the focal region plus 2 cm margin with 6MeV electron to a total dose of 50 Gy in 25 fractions. However, the treatment was early terminated at 20 Gy due to painful grade III dermatitis. In search of appropriate alternative treatment, 5% imiquimod cream was chosen due to its relatively mild possible adverse effects. The cream was applied on the lesions and up to 2 cm outside their visible margins every other day. After three weeks of topical cream treatment, at least partial response had been observed. She lost of follow-up after 5 weeks of treatment. After repetitively calling her for follow-up, she showed up 6 months later. There were still some suspicious skin lesions although the previously noted nodule was completely gone and most of the patchy lesions were remitted.

關鍵字

Vulvar Paget's Disease ； Radiotherapy ； Imiquimod 5% cream

並列摘要

乳房以外的佩吉特氏症是一種罕見的表皮腺癌，多見於汗腺豐富的區域。約60%的乳房以外的佩吉特氏症發生於外陰部，而外陰部佩吉特氏症約占外陰部惡性腫瘤的1%。一位95 017２０１歲的女性於過去兩年多的期間，飽受外陰部紅腫、結痂、滲液的困擾，在本院皮膚科門診時也在外陰部發現一顆一公分大的結節。經切片後證實為佩吉特氏症。考慮到她高齡及獨居的狀況，決定不以手術切除而採放射治療。原訂以6 MeV電子至少照射25次至50 Gy劑量。但因放射性皮膚炎而於20 Gy時中止。改採imiquimod 5%乳膏治療，每兩日塗抹於病灶及其邊緣外加2公分之範圍。三週後已見到病灶明顯縮小。後因她行動不便而未前來接受治療，療程僅維持共五週。六個月後回診，原本的結節已消失，大部分病灶也均消失，但仍有部分紅色斑塊疑似殘存腫瘤。

並列關鍵字

外陰部佩吉特氏症 ； 放射治療 ； Imiquimod 5%乳膏