Abstract
PurposeTotal skin electron beam therapy (TSEBT) is used mostly in the treatment of cutaneous T cell lymphoma. In this study we describe the results of TSEBT applied in the Netherlands using two different schedules, a conventional dose schedule of 35 Gy and a low-dose schedule of 12 Gy. We aimed to evaluate the treatment results in and compare treatment outcomes between the two treatment groups and to further define indications for both doses. MethodsIn the LUMC, Leiden, we performed a retrospective analysis of 51 patients treated with TSEBT between January 2008 and December 2018, with follow-up untill December 2019. Thirty one patients were treated with 35 Gy and twenty with 12 Gy. The dose was chosen based on the severity of skin involvement. Outcome measures were time to meaningful progression, survival, response rate and toxicity. ResultsTime to meaningful progression was 5.1 months with no significant differences between dose groups (P = 0.77). Overall survival was 27.4 months. Both time to progression and survival were significantly better for T2 vs T3 stage. Overall response rate was 80.4 %. Both dose groups showed improvement of symptoms. Treatment was generally well tolerated. ConclusionsBoth high-dose and low-dose TSEBT offer similar results for TMP and OS. It remains unclear which patients benefit most from a high-dose schedule. We propose to use the low-dose schedule as a standard for TSEBT and use supplementary boosts or escalation to high-dose treatment for patients unresponsive to the low-dose schedule.
Highlights
Mycosis Fungoides (MF) and Sezary Syndrome are the most common cutaneous T cell lymphomas
A total of 51 patients were included in the study of whom 31 (60.8%) received high-dose Total skin electron beam therapy (TSEBT) and 20 (39.2%) low-dose TSEBT
Most pa tients were diagnosed with MF (N = 46), but a small number of patients were treated for Sezary Syndrome (N = 2) or another cutaneous mani festation of T-cell lymphoma (N = 3)
Summary
Mycosis Fungoides (MF) and Sezary Syndrome are the most common cutaneous T cell lymphomas. MF is characterized by a variety of skin lesions such as patches, plaques, tumors and erythroderma, either localized or widespread. There may be involvement of lymph nodes or visceral organs at presentation or later on in the disease course this occurs rarely. Sezary Syndrome is a distinctive disease with blood involvement of the malignant T-cells of the skin. Both diseases are staged by the TNMB classification [1]. Both type and number of skin lesions as well as the TNMB classification are indicators of prognosis [2,3,4]
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