Treatment of mycosis fungoides: total-skin electron-beam irradiation vs topical mechlorethamine therapy

Abstract

Of 42 patients who had mycosis fungoides (MF) confined to the skin with or without dermatopathic lymphadenopathy, 21 were treated with topically applied mechlorethamine hydrochloride and 21 with total-skin electron-beam irradiation. The results of both therapeutic modalities are compared. We conclude that, in the early stage of the disease, both forms of treatment are equally effective. In the later stages of MF, in the absence of lymph node or other systemic involvement, electron-beam irradiation seems to be superior in inducing an initial complete remission. However, because of the large number of patients who have a relapse after this therapy, it should be followed by topical mechlorethamine therapy.

Ultimate results of radiation therapy for T1-T2 mycosis fungoides (including reirradiation)

“…Total skin electron beam therapy (TSEBT) has been the first, and for a while the only, single effective modality able to cure patients with limited or spreading skin-confined disease. Many authors published encouraging results concerning its feasibility and efficacy, providing remission, stabilization, or palliation of symptoms (2,(5)(6)(7)16). Such a technique is able to deliver a skin surface dose above 30 Gy (usually 35-36 Gy) delivered with electrons of at least 4-MeV (usually 6-MeV) energy (2)(3)(4).…”

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

“…However, this efficacy did not translate into a long-term survival benefit (10-year overall survival (OS), 87 and 87%; p = 0.2). In addition, TSEBT is a reasonable treatment option for patients with T2 and T3 disease owing to its penetration ability, which seems to be superior to that of mechlorethamine [44,45]. TSEBT for T4 disease or SS remains controversial.…”

Skin-Directed Therapies in Cutaneous T-Cell Lymphoma

“…Most of these studies evaluated efficacy of aqueous preparations of nitrogen mustard in MF. [33][34][35] In 1982, Hamminga and colleagues 33 reported on a retrospective study of 42 patients with MF, including 10 patients with tumor-stage MF, who were treated with either total-body aqueous mechlorethamine or total-body (skin) electron beam irradiation (TSEB) (2800-3000 rad). Of the patients with early stage MF treated with TSEB, 100% had an initial CR compared with the 82% treated with aqueous mechlorethamine.…”

“…Lower concentrations should be used when patients show an allergic or irritant reaction. 31,[33][34][35][36] Ointment preparations are made by mixing 10 mg of Mustargen first with 95% alcohol to remove the powder in the vial and then in 100 g of Aquaphor (a nonpolar and anhydrous vehicle with a low incidence of sensitization) to a final concentration of 0.2 mg/mL, which can be applied once daily to the whole body in generalized disease or to lesional skin in localized disease. 31,37,38 It is recommended that application of the medication should occur on dry skin 4 hours before or 30 minutes after showering.…”

“…52 Treatment with Valchlor has not been evaluated in stage IIA patients but, based on earlier studies with the extemporaneous compounded nitrogen mustard preparations, is likely to be effective. 31,[33][34][35] In general, although the mechanism of action of topical nitrogen mustard is unclear, it represents an efficacious option for early stage MF with its use mainly limited by delayed contact hypersensitivity.…”