The Results of Low-Dose Total Skin Electron Beam Radiation Therapy (TSEB) in Patients With Mycosis Fungoides From the UK Cutaneous Lymphoma Group

Abstract

Total skin electron beam radiation therapy (TSEB) is a very effective treatment of mycosis fungoides. Following reports of similar durations of response to lower doses of TSEB, a low-dose schedule of TSEB was introduced in the United Kingdom. A protocol of 12Gy in 8 fractions over a period of 2weeks was agreed on by use of the Stanford University technique.Data were collected prospectively, and the results were analyzed according to the European Organisation for Research and Treatment of Cancer-International Society for Cutaneous Lymphomas endpoints (EORTC-ISCL). Toxicity was scored according to CTCAE v4.0 (Common Terminology Criteria for Adverse Events version 4.0). One hundred three patients received treatment, with a median follow-up period of 20.6months (range, 3.3-53months). Of these patients, 54 had stage IB disease, 33 had stage IIB, 12 had stage III, and 4 had stage IV. The median age was 68years (range, 26-91years). The complete response rate was 18%, the partial response rate was 69%, stable disease was present in 8%, and progression on treatment was found in 5%. In the patients who had a complete response, the median time to relapse was 7.3months. The median response duration was 11.8months. Median progression-free survival for all patients was 13.2months. It was significantly longer, at 26.5months, in patients with stage IB disease compared with 11.3months in patients with stage IIB (P=.003; hazard ratio, 2.66) and 10.2months in patients with stage III (P=.002; hazard ratio, 4.62).The treatment was well tolerated with lower toxicity than higher-dose schedules. The low-dose TSEB schedule of 12Gy in 8 fractions over a period of 2weeks is well tolerated and is an effective option for patients with mycosis fungoides.