Total skin electron beam therapy for primary cutaneous T-cell lymphomas: clinical characteristics and outcomes in a Mexican reference center

Abstract

Aim: The aim of this study was to assess treatment modalities, treatment response, toxicity profile, disease progression and outcomes in 14 patients with a confirmed diagnosis of primary cutaneous T-cell lymphoma (PCTCL) treated with total skin electron beam therapy (TSEBT).

Background: Primary cutaneous lymphomas (PCLs) are extranodal non-Hodgkin lymphomas originating in the skin without evidence of extracutaneous disease at diagnosis. Despite advances in systemic and local therapy options, the management of advanced stages remains mostly palliative.

Materials and methods: This is a retrospective study of patients with PCTCL, diagnosed and treated in a reference center in Mexico City, analyzing treatment modalities, response to treatment, long-term outcome, and mortality.

Results: Eight males (57%) and 6 (43%) females were identified. Most patients were stage IVA (n = 5, 36%) followed by stage IB and IIB (28.5% and 21.4%, respectively). Eleven patients received the low-dose RT scheme (12 Gy), 1 patient, the intermediate-dose RT scheme (24 Gy), and 2 patients, the conventional-dose RT scheme (36 Gy). Mean follow-up time was 4.6 years. At first follow-up examination, 6-8 weeks after radiotherapy, the overall response rate (ORR) for the cohort was 85%. The median PFS for the whole cohort was 6 months.

Conclusion: This study reinforces the role of TSEBT when compared with other treatment modalities and novel agents. Low-dose TSEBT is now widely used because of the opportunity for retreatment.

Keywords: CI, Confidence interval; CR, Complete response; Cutaneous lymphoma; EORTC, European Organisation for Research and Treatment of Cancer; LCT, Large cell transformation; LPD, Lymphoproliferative disorder; MF, Mycosis fungoides; Mycosis fungoides; NHL, Non-Hodgkin lymphomas; ORR, Overall response rate; OS, Overall survival; PCL, Primary cutaneous lymphoma; PCTCL, Primary cutaneous T-cell lymphomas; PFS, Progression-free survival; RT, Radiotherapy; SD, Standard deviation; SS, Sézary syndrome; Sézary syndrome; TSEBT, Total skin electron beam therapy; Total skin electron beam therapy.; UV, Ultraviolet.

Fig. 1

a. Dosimetry test performed using a plane-parallel ion chamber, twelve semiconductor diodes, an in-vivo dosimetry electrometer. Fig. 1.b. Vivo Soft software showing lectures captured by semiconductor diodes.

Fig. 2

a. In-vivo dosimetry of a patient with PCTCL to adjust MU in underdosed areas. The anterior field with two posterior oblique fields on day one followed by the posterior with two anterior oblique fields on the second day were administered. Fig. 2.b. Vivo soft reading of in-vivo dosimetry. Abbreviations: PCTCL, primary cutaneous T-cell lymphoma.

Fig. 3

Personalized shielding of eyes and nails is made for every patient treated at our Institution.

Fig. 4

a. Patient with Primary cutaneous peripheral T-cell lymphoma, not otherwise specified before starting TSEBT. Fig. 4b. The same patient 1 month after finishing middle-dose TSEBT. Abbreviations: TSEBT, total skin electron beam therapy.