Quality of Life Improvement Following Low-Dose Total Skin Electron Beam Therapy in Patients with Mycosis Fungoides or Sezary Syndrome

Abstract

Total skin electron beam therapy (TSEBT) has proved to be a safe and effective treatment for cutaneous T-cell lymphomas. Here, we report our experience applying low-dose TSEBT to patients with mycosis fungoides (MF) or Sezary syndrome (SS). We examined the impact of this treatment on patient quality of life and outcome. Forty-four patients with MF or SS received 48 TSEBT courses with a median dose of 12 Gy (range, 12–24) within the past eight years at our institute. Patient and treatment characteristics for these cases, as well as the impact of TSEBT on quality of life and duration of response, were retrospectively analyzed and compared. The median modified Severity Weighted Assessment Tool score before the start of TSEB was 44 (mean: 57, range: 7–160). The overall response rate was 88%, with a complete response (CR) rate of 33%. Five patients (10%) had near CR (< 1% body surface area). Pruritus improved significantly in 84% of the patients treated (CR rate, 35%). The median follow-up period was 13 months. The median duration of response (DOR), progression-free survival (PFS), and overall survival (OS) for the entire cohort were 10 months, 9 months, and 20 months, respectively. Patients who received maintenance treatments had a longer DOR (13 months vs. 6 months, respectively; P = 0.1), PFS (9 months vs. 3 months, respectively; P = 0.01), and OS (51 months vs. 18 months, respectively; P = 0.15). Meanwhile, patients presenting CR had a noticeably longer PFS (13 months vs. 7 months, respectively; P = 0.05). Patient-reported symptom burden was measured with Dermatological Life Quality Index and Skindex-29 questionnaires. The mean symptom reductions were 6 ± 8 (P = 0.005) and 21 ± 24 (P = 0.002), respectively. In the Functional Assessment of Cancer Therapy-General assessment, significant improvements in both the emotional (P = 0.03) and social (P = 0.08) domains were observed after TSEBT. In univariate analyses, various clinical and hematological parameters were found to be significant. In a multivariate analysis, only CD30+ MF was associated with improved DOR (P = 0.05) and PFS (P = 0.05), while disease stage appears to potentially impact OS (P = 0.06). Taken together, these results indicate that maintenance of TSEBT improves the PFS of patients with MF or SS. In addition, TSEBT improved disease symptoms and significantly improved emotional and social domains of patients’ quality of life.