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

Abstract

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.

Combined total skin radiotherapy and immune checkpoint inhibitors: A promising potential treatment for mycosis fungoides and Sezary syndrome

“…TSEB is a feasible option for MF patients with T2-T4 lesions and SS. Recently, low-dose TSEB schedules (10)(11)(12) have demonstrated acceptable disease control with markedly lower toxicity than conventional-dose TSEB [5,27]. Following 12 Gy TSEB, ORRs up to 95 % (complete response rate 33 %) have been reached (Table 2).…”

“…The choice of treatment strategy is based on disease stage and the latest evidence-based guidelines [2][3][4]. Skin-directed treatments, including radiotherapy and systemic therapy, are often used with acceptable results [5][6][7]. Systemic chemotherapy is used primarily for palliation [8,9].…”

Low- vs. Middle-dose Total Skin Electron Beam Therapy for Mycosis Fungoides: An Efficiency-based Retrospective Survey of Skin Response

“…More recently, low-dose TSEBT (4-10 Gy) has been proposed in MF and supported by a number of reports (19)(20)(21)(22)(23)(24)(25)(26). Three of these are prospective studies and 4 are retrospective for a total of 286 patients.…”

Remarkable Advances in the Management of Mycosis Fungoides and the Sezary Syndrome

“…Both Elsayad et al [4] and Dabaja et al [5] in their papers discuss the reconsideration of radiation therapy dose for managing mycosis fungoides. In 1978, at the time of the NCI workshop, with so few therapies being available for treatment, the philosophy was to maximize management with any single modality in order to optimize outcome.…”

“…Elsayad et al [4] provide a table summarizing the use of adjuvant therapies in this setting. Most of the experience relates to mechlorethamine, PUVA and miscellaneous therapies.…”