Total Skin Irradiation in the Treatment of Primary Cutaneous Lymphomas: a Literature Review and Clinical Cases

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Introduction: Primary cutaneous lymphomas represent a heterogeneous group of diseases, the treatment of advanced stages of which requires a comprehensive approach, including systemic therapy and skin-directed methods. Total skin electron irradiation (TSEB) demonstrates high efficacy due to the radiosensitivity of lymphoid cells. Despite the high overall response rate, the recommended dose ranges and fractionation schemes for TSEB vary, necessitating detailed investigation. Stratification of patients by clinical stage, type of lesions, and the extent of skin involvement is crucial for optimizing TSEB, improving outcomes, and reducing side effects.Total skin electron beam radiotherapy: A Trend Toward Low Doses: TSEB with cumulative doses of 30ʹ36 Gy has established itself as an effective treatment method; however, there is growing interest in lower doses (10ʹ29 Gy) due to the high radiosensitivity of lymphomas and the need to reduce radiation-related side effects. Studies have confirmed a high overall response to low doses, especially in early stages, with less pronounced radiation reactions and a comparable median duration of response. To optimize the approach, further research is needed, including the development of patient selection criteria and dose individualization with a potential boost to large lesions.Conclusions: The question of the optimal cumulative dose for TSEB in patients with primary cutaneous lymphomas remains insufficiently studied. Clinical cases confirm the efficacy of both standard doses (30ʹ36 Gy) and low doses (10ʹ20 Gy), demonstrating good clinical responses, symptom reduction, and lower toxicity. Low dose TSEB provides a comparable overall response to standard doses, reduces the number of treatment visits, and enables retreatment in case of disease relapse. The main tasks remain to study the factors influencing dose selection (disease stage, type of lesions, individual patient characteristics) and to develop patient management strategies. TSEB effectively controls disease manifestations even in complex cases. Data analysis highlights the need for unified patient selection criteria and optimization of irradiation techniques to improve outcomes and reduce treatment toxicity.