Abstract
The treatment of advanced stage MF is especially challenging as single agent overall response rates are in the 35% range and chronic recurrence is the rule. The treatment of CTCL across all stages of disease is aimed at the goal of achieving and sustaining remission. Increasingly, low dose total skin electron beam therapy (TSEBT) is being utilized as a skin directed component in combination therapy for advanced stage CTCL. Researchers are seeking to better define the utility of low dose TSEBT as a method of debulking skin disease while simultaneously treating other disease compartments and in combination with sustained maintenance therapies of both the skin directed and systemic varieties. Data exists showing the efficacy of low dose TSEBT in early and advanced disease. There is also data documenting prolonged treatment responses with TSEBT plus adjuvant skin directed therapies such as PUVA and topical nitrogen mustard. Emerging data examining the role of low dose TSEBT in the prestem cell transplant preparation is also promising. This brief review summarizes the utility of low dose TSEBT in multiagent treatment regimens in CTCL.
Highlights
Cutaneous lymphomas represent 3.9% of all non-Hodgkin lymphomas [1]
We present a review of total skin electron beam therapy (TSEBT) and highlight the efficacy of low-dose TSEBT use in conjunction with adjuvant therapy
This study found that TSEBT with subsequent adjuvant HN2 treatment prolonged the duration of response [32]
Summary
Mycosis fungoides (MF) and sezary syndrome (the leukemic variant) constitute approximately 53% of all cutaneous lymphomas, and are collectively termed cutaneous T-cell lymphoma (CTCL) [2]. Mycosis fungoides is the most common variant of CTCL and is defined as a malignancy of skin resident CD4+ T effector memory cells with characteristic loss of CD7 and CD26 [3] [4]. The annual age-adjusted incidence is 9.6 cases per million people in the United States, and it appears to have increased over the last 3 decades [5]. The atypical lymphocytes in MF are exquisitely radiosensitive rendering radiation therapy a useful treatment modality in early and advanced stage disease [14]. Low dose total skin electron beam therapy (TSEBT) is being utilized as skin directed component in combination therapy for advanced stage CTCL. We present a review of TSEBT and highlight the efficacy of low-dose TSEBT use in conjunction with adjuvant therapy
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