The role of radiotherapy in the treatment of malignant sweat gland neoplasms

Abstract

Malignant sweat gland neoplasms are rare tumors. Historically, the principal mode of treatment has been local surgical excision. Eight published studies show that greater than 50% of patients develop either local tumor recurrence after surgery or regional lymph node metastases. Most patients have evidence of locoregional failure before distant metastases are detected. Three patients were recently referred to the University of Arizona Cancer Center for consideration of irradiation after resection of such tumors. In two patients, the tumor was located on the scalp and, in one patient, on the alar surface of the nose. Their ages ranged from 19 to 60 years. All underwent surgical resection followed by high-dose irradiation of the surgical bed (approximately 70 Gy) and regional lymphatic chains (approximately 50 Gy). Two patients remain disease-free at 27 and 35 months, respectively, after completion of treatment; the third died of rapidly progressive systemic metastases. A review of the literature is provided focusing on treatment success and predominant patterns of recurrence. Finally, a rational approach for evaluation of patients that might benefit from local irradiation is presented.

A Rare Case of Malignant Acrospiroma Masquerading as Squamous Cell Carcinoma of Scalp

“…8 The dose of radiation was 70 gray for surgical bed and 50 gray for regional lymphatic chains. 8 However, in our case patient was not subjected to any adjuvant therapy in the form of chemotherapy or radiotherapy, since wound was allowed to heal by granulation tissue formation followed by skin grafting. Hence, patient was not subjected to radiotherapy.…”

Hidradenocarcinoma of scalp: a case report and review of literature

“…Harari and colleagues reported complete remissions with external beam radiotherapy of sweat gland tumours with positive margins after surgery. 14 Lerner et al have mentioned that their patient with unresectable metastatic hidradenocarcinoma had complete clinical and radiological response with 3 months of oral capecitabine.…”

Malignant eccrine acrospiroma with nodal and bone metastasis

“…They suggested that certain histological features such as dermal lymphatic invasion, nerve sheath involvement, deep structural infiltration, positive resected margins, and extracapsular lymph node extension may identify a high risk of recurrence and merit postoperative radiotherapy. [12] The role of chemotherapy in eccrine sweat gland carcinomas, and especially malignant acrospiromas, is not clear. Various case reports and case series have reported on the use of a multitude of drugs in various sweat gland carcinomas including cyclophosphamide and doxorubicin, bleomycin, cisplatin, mitomycin C, with partial response and a median duration of response of 4 to 16 months.…”