Does adjuvant alpha-interferon improve outcome when combined with total skin irradiation for mycosis fungoides?

Roberge, David; Muanza, Thierry; Blake, Gerald; Shustik, Chaim; Vuong, T.; Freeman, Carolyn R.

doi:10.1111/j.1365-2133.2006.07559.x

Cited by 24 publications

(11 citation statements)

References 20 publications

(29 reference statements)

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“…This observation is in accordance with some (13, 14) but not all (1, 15, 16) previous reports. In a previous study, the lack of improvement due to maintenance therapy was attributed to the relatively small number of pretreatments and short duration of adjuvant nitrogen mustard (1).…”

Section: Discussionsupporting

confidence: 94%

Total Skin Electron Therapy for Cutaneous T-Cell Lymphoma Using a Modern Dual-Field Rotational Technique

Heumann

Esiashvili

Parker

et al. 2015

International Journal of Radiation Oncology*Biology*Physics

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Purpose To report our experience with rotational total skin electron irradiation (RTSEI) in cutaneous T-cell lymphoma (CTCL), and to examine response by disease stage and race. Methods and Materials We reviewed our outcomes for 68 CTCL patients who received RTSEI (≥30 Gy) from 2000 to 2013. Primary outcomes were complete clinical response (CCR), recurrence-free survival (RFS), and overall survival (OS). Using log–rank tests and Cox proportional hazards, OS and RFS were compared across tumor stages at time of RTSEI with further racial subgroup analysis. Results Median age at diagnosis and at time of radiation was 52 and 56 years, respectively. Median follow-up was 5.1 years, 49% were African American, and 49% were female. At time of treatment, 18, 37, and 13 patients were T stage 2, 3, and 4, respectively. At 6 weeks after RTSEI, overall CCR was 82% (88%, 83%, and 69% for T2, T3, and T4, respectively). Median RFS was 11 months for all patients and 14, 10, and 12 months for stage T2, T3, and T4, respectively. Tumor stage was not associated with RFS or CCR. Maintenance therapy after RTSEI was associated with improved RFS in both crude and multivariable analysis, controlling for T stage. Median OS was 76 months (91 and 59 months for T3 and T4, respectively). With the exception of improved OS in African Americans compared with whites at stage T2, race was not associated with CCR, RFS, or OS. Conclusions These results represent the largest RTSEI clinical outcomes study in the modern era using a dual-field rotational technique. Our observed response rates match or improve upon the standard set by previous outcome studies using conventional TSEI techniques, despite a large percentage of advanced CTCL lesions in our cohort. We found that clinical response after RTSEI did not seem to be affected by T stage or race.

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Section: Discussionsupporting

confidence: 94%

Total Skin Electron Therapy for Cutaneous T-Cell Lymphoma Using a Modern Dual-Field Rotational Technique

Heumann

Esiashvili

Parker

et al. 2015

International Journal of Radiation Oncology*Biology*Physics

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“…In addition to IFN alfa, agents most often included in multimodality treatment include PUVA, oral retinoids, and ECP. Although there are reports of successful responses to the combinations of vorinostat/IFN alfa-2a/ ECP, 82 IFN alfa-2a/ECP/PUVA, 83 and IFN alfa/ ECP/IL-2 84 and retrospective cohort analyses that promote the multimodality approach, 75,85 none of the available literature includes trials that directly compare multimodality regimens to either each other or to regimens consisting of 1 to 2 treatments. Nevertheless, the authors' center routinely treats more advanced stages of CTCL with multimodality regimens that most often include IFN, an oral retinoid, skin-directed therapy, and/or ECP.…”

Section: Spaccarelli and Rookmentioning

confidence: 96%

The Use of Interferons in the Treatment of Cutaneous T-Cell Lymphoma

Spaccarelli

Rook

2015

Dermatologic Clinics

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Interferons are polypeptides that naturally occur in the human body as a part of the innate immune response. By harnessing these immunomodulatory functions, synthetic interferons have shown efficacy in combating various diseases including cutaneous T-cell lymphoma. This article closely examines the qualities of interferon alfa and interferon gamma and the evidence behind their use in the 2 most common types of cutaneous T-cell lymphomas, namely, mycosis fungoides and Sézary syndrome.

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“…Regarding previous therapies, a tendency to sustain TSEBT effectiveness in patients treated previously with mechlorethamine has been observed [49]. Combined TSEBT and IFN (for 1 year) is a feasible option, with increased but acceptable acute toxicity, though the addition of IFN did not improve outcome per se [50]. In contrast, a combination of conventional-dose TSEBT with concurrent oral retinoids has shown an acceptable toxicity profile without compromising either therapy [38,51].…”

Section: Tsebt Resultsmentioning

confidence: 99%

Total Skin Electron Beam Therapy as Part of Multimodal Treatment Strategies for Primary Cutaneous T-Cell Lymphoma

Elsayad

Susek

Eich³

2017

Oncol Res Treat

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Total-skin electron beam therapy (TSEBT) is one of most effective treatments that has been used for cutaneous T-cell lymphoma. Low-dose TSEBT regimens (10-12 Gy) appear to be an effective alternative to conventional-dose TSEBT (30-36 Gy), yielding short-term remission of cutaneous manifestations with minimal toxicity. TSEBT can be administered to patients any time after a diagnosis of mycosis fungoides (MF). Patients requiring rapid relief from cutaneous lesions or symptoms may particularly benefit from TSEBT as an initial therapy. Radiotherapy (RT) dose, boost radiation delivery, maintenance treatment, and radiation tolerability may enhance remission rates and improve relapse-free survival following TSEBT. In addition, salvage local RT or TSEBT may be safely applied with high effectiveness. In this review, we focus on the use of TSEBT in patients with several forms of primary cutaneous T-cell lymphoma, and highlight the potential of low-dose TSEBT as part of a promising therapeutic approach.

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Does adjuvant alpha-interferon improve outcome when combined with total skin irradiation for mycosis fungoides?

Abstract: Concurrent IFN and TSEI is feasible, with acceptable toxicity. Even when controlling for disease stage, the addition of IFN did not appear to increase CR rate, disease-free survival or OS.

Cited by 24 publications

References 20 publications

Total Skin Electron Therapy for Cutaneous T-Cell Lymphoma Using a Modern Dual-Field Rotational Technique

Total Skin Electron Therapy for Cutaneous T-Cell Lymphoma Using a Modern Dual-Field Rotational Technique

The Use of Interferons in the Treatment of Cutaneous T-Cell Lymphoma

Total Skin Electron Beam Therapy as Part of Multimodal Treatment Strategies for Primary Cutaneous T-Cell Lymphoma

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