Fine-Tuning Low-Dose Total Skin Electron Therapy for Optimal Management of Cutaneous T-Cell Lymphoma: A Comparative Analysis of Regimens

Brady S Laughlin; Charles Van Der Walt; Aaron R Mangold; William G Breen; Allison C Rosenthal; Scott Lester; Bradford Hoppe; Jennifer Peterson; Aaron Bogan; William G Rule

doi:10.1016/j.adro.2024.101502

Fine-Tuning Low-Dose Total Skin Electron Therapy for Optimal Management of Cutaneous T-Cell Lymphoma: A Comparative Analysis of Regimens

Adv Radiat Oncol. 2024 Mar 24;9(7):101502. doi: 10.1016/j.adro.2024.101502. eCollection 2024 Jul.

Authors

Affiliations

¹ Department of Radiation Oncology, Mayo Clinic, Phoenix, Arizona.
² Department of Quantitative Health Sciences, Section of Biostatistics, Mayo Clinic, Scottsdale, Arizona.
³ Department of Dermatology, Mayo Clinic, Phoenix, Arizona.
⁴ Department of Radiation Oncology, Mayo Clinic, Rochester, Minnesota.
⁵ Department of Hematology and Oncology, Mayo Clinic, Phoenix, Arizona.
⁶ Department of Radiation Oncology, Mayo Clinic, Jacksonville, Florida.

Abstract

Purpose: Low-dose total skin electron beam therapy (TSEBT) is a proven treatment for managing cutaneous T-cell lymphoma (CTCL) and Sezary syndrome with skin burden. We performed a retrospective comparison of response rates and time to progression for patients receiving low-dose TSEBT based on dose per fractionation, total dose, and stage.

Methods and materials: One hundred and ten patients with CTCL and Sezary syndrome were treated with 135 courses of low-dose (400-1500 cGy) TSEBT or subtotal skin electron therapy at multiple centers of a single institution between August 2003 and June 2023. Patients were stratified according to total dose, dose per fraction, and stage.

Results: The median follow-up was 301 days (IQR, 141, 767). The median age at treatment was 69.9 years (range, 29.7-96.5). T-stage distribution was as follows: 3 (2.7%) T1, 74 (67.3%) T2, 16 (14.5%) T3, and 17 (15.5%) T4. American Joint Committee on Cancer eighth edition stage distribution was as follows: 3 (2.7%) IA, 53 (48.2%) IB, 3 (2.7%) IIA, 16 (14.5%) IIB, 8 (7.3%) IIIA, 19 (17.3%) IVA, and 8 (7.3%) IVB. There was no significant difference in disease distribution between patients treated with different fractionation schemes. The overall response rate was 89.6%. Forty-four courses (32.6%), 34 courses (25.2%), and 43 (31.9%) resulted in a complete, near-complete, and partial response, respectively. Fourteen courses (10.4%) resulted in no clinical response. For all patients, the median time to response was 43.0 days (IQR, 23.0-70). The median time to skin progression for all patients was 107.5 days (IQR, 67.8-233.5).

Conclusions: This analysis demonstrated that CTCL patients treated with low-dose radiation therapy delivered over various fractionation schemes had similar overall response rates and median time to progression.