Acute and sub-acute toxicity profile of ultra-hypofractionated low-dose total skin electron beam with two 4 Gy fractions for cutaneous T cell lymphoma

Daniel Rolf,Khaled Elsayad,Hans Theodor Eich

doi:10.1007/s00432-020-03449-7

Abstract

PurposeLow-dose total skin electron beam therapy (TSEBT) over 3 weeks has proved to be a safe and effective treatment for cutaneous T cell lymphomas (CTCL). In this prospective trial, we examined the feasibility of ultra-hypofractionated low-dose TSEBT regimen in two fractions with 4 Gy combined with systemic therapy to minimize the number of visits to radiation centers.Patients and methodsSix patients with mycosis fungoides (MF) or Sézary syndrome (SS) received TSEBT with a total radiation dose of 8 Gy in two fractions between April 2020 and June 2020. Patient and treatment characteristics, tumor burden, the impact on the quality of life using Skindex-29 questionnaires, and acute toxicities were analyzed.ResultsDuring TSEBT, all patients developed grade 1 toxicities while two patients developed grade 2 toxicities. One patient experienced sepsis. The most common adverse effects were erythema and edema. All grade 2 toxicities regressed after 4 weeks following TSEBT. Based on the reported symptoms measured by Skindex-29, we detected a significant reduction in total Skindex-29 score after 8 weeks of radiation (P = 0.03), particularly in the symptoms (P = 0.01) and emotional domains (P = 0.04).ConclusionUltra-hypofractionated low-dose TSEBT followed by systemic therapy seems to be a safe and feasible alternative to conventional fractionated TSEBT for patients with MF/SS. The skin tumor burden and the health-related quality of life have been significantly improved within 8 weeks following radiotherapy.

Highlights

Nowadays, there is a global need to reduce cancer patients and radiation oncology staff’s exposure to the potential risk of COVID-19 infection, or due to limited resources (Chen et al 2020)
Six hypofractionated low-dose total skin electron beam therapy (TSEBT) courses were administered to six patients with cutaneous T cell lymphoma (CTCL) at our institution during COVID-19 pandemic from 04 to 06/2020 (Table 1)
The inclusion criteria involved: patients with a histologically confirmed diagnosis of mycosis fungoides stage IIB–IV or Sézary syndrome and planned TSEBT combined with systemic treatment

Summary

Introduction

There is a global need to reduce cancer patients and radiation oncology staff’s exposure to the potential risk of COVID-19 infection, or due to limited resources (Chen et al 2020). Low-dose total skin electron beam therapy (TSEBT) in the range of 10–12 Gy over 3 weeks is a current treatment option for cutaneous T cell lymphoma (CTCL) with excellent response rate and minimal risk of adverse. Daniel Rolf and Khaled Elsayad contributed to this work. We present the feasibility of ultra-hypofractionated low-dose TSEBT followed by maintenance therapies in CTCL. Patient Sex/age (years) Diagnosis/ TSEBT dose Concurrent clinical therapy stage. Acute toxicities Sub-acute toxici- Response mSWAT reduc- PFS (W) FU. Journal of Cancer Research and Clinical Oncology (2021) 147:1757–1761 M/69 M/66

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