The effect of phototherapy on progression to tumors in patients with patch and plaque stage of mycosis fungoides

Abstract

Background: Phototherapy has been a mainstay in the treatment of mycosis fungoides (MF). However, the recent findings of UV-induced p53 mutations in advanced MF suggest that phototherapy may contribute to disease progression. Objective: The objective of this study was to evaluate the effect of phototherapy on the time to tumor progression and overall survival in MF. Materials and methods: Retrospective analysis of patients seen at the University of Pittsburgh Cutaneous Lymphoma Clinic from 1979 to 2016. Results: 345 patients with MF were identified. 258 (74.8%) were diagnosed at stage IA or IB. 43 out of 258 (16.6%) progressed to tumor stage. Before tumor development, 30 out of 43 (69.8%) patients received phototherapy, and 13 (30.2%) did not. Patients who received phototherapy had a longer median time to tumor progression than those who did not: 3.5 years (interquartile range = 1.9 – 5.7) versus 1.2 years (0.2 – 2.3) (p =0.001). Patients who received phototherapy also survived longer: 6.9 years (interquartile range = 4.3 – 9.5) versus 3.8 years (3.0 – 4.5) (p = 0.014). Limitations: Limited information on specific phototherapy start dates, durations, and treatment protocols. Conclusions: The therapeutic effects of phototherapy, with longer times to tumor progression and increased overall survival, appear to outweigh its potential adverse effects.

A Perspective on the Use of NB-UVB Phototherapy vs. PUVA Photochemotherapy

“…It is unclear whether phototherapy has any impact on limiting natural disease progression. Based on one study it was suggested that tumor stage CTCL was slower to develop and overall survival was improved in those who had previously received phototherapy, although given the retrospective nature of the study these data must not be obver-interpreted ( 69 ). For thicker plaque stage CTCL, the increased depth of penetration of PUVA is desirable and NB-UVB would not be indicated, whereas PUVA would be the phototherapeutic modality of choice ( 5 ).…”

Real-Life Barriers to Diagnosis of Early Mycosis Fungoides: An International Expert Panel Discussion

“…Early diagnosis is important across all disease stages to allow timely appropriate management and avoidance of potentially harmful treatments, which may worsen cutaneous lesions and fuel disease progression, and to reduce patient distress [12][13][14][15]. Early diagnosis may also modify the subsequent disease course [16][17][18]. Some international guidelines recognize watchful waiting for patients with limited, stage IA MF [19,20], while National Comprehensive Cancer Network guidelines also recommend interventional treatment [21].…”

Ultraviolet phototherapy for treatment of various dermatoses

“…60 A comparative study of 43 MF patients showed that patients receiving PUVA or NB-UVB had a longer median progression from patch and plaque stage to tumor stage as well as life expectancy compared to patients who did not receive phototherapy. 61 In 2015, the American Academy of Dermatology published phototherapy guidelines for MF. The dose of 8-methoxy psoralen (8-MOP) is 0.6 mg/kg with UVA exposure 2 hours thereafter.…”