The results of Low dose Total Skin Electron Beam Radiotherapy (TSEB), in patients with mycosis fungoides from the UK cutaneous lymphoma group

Publication date: Available online 9 June 2017
Source:International Journal of Radiation Oncology*Biology*Physics
Author(s): Stephen L. Morris, Julia Scarisbrick, John Frew J, Clive Irwin, Robert Grieve, Caroline Humber, Aleksandra Kuciejewska, Sally Bayne, Sophie Weatherhead, Fiona Child, Mary Wain, Sean Whittaker
IntroductionTSEB is a very effective treatment for mycosis fungoides. Following reports of similar durations of response to lower doses of TSEB a low dose schedule of TSEB was introduced in the UK.MethodsA 2-week protocol of 12Gy in 8 fractions over 2 weeks was agreed, using the Stanford technique. Data was collected prospectively and the results analysed according to the EORTC/ISCL endpoints. Toxicity was scored according to the CTCAEv4.0.Results103 patients received treatment with a median follow up of 20.6 months (range 3.3 to 53 months). 54 patients were stage IB, 33 stage IIB, 12 stage III and 4 stage IV. The median age was 68 (range 26 – 91). The complete response rate was 18%, partial response rate 69%, stable disease 8% and 5% progressed on treatment. In the patients who had a complete response the median time to relapse was 7.3 months. The median response duration was 11.8 months. The median PFS for all patients was 13.2 months. It was significantly longer at 26.5 months in Stage IB patients compared to 11.3 months in Stage IIB patients (p=0.003, HR 2.66) and 10.2 months in stage III patients (p=0.002, HR 4.62). The treatment was well tolerated with lower toxicity than higher dose schedules.ConclusionsThe low dose 12Gy in 8-fraction schedule of TSEB over 2 weeks is well tolerated and is an effective option for patients with mycosis fungoides.

Teaser

30Gy in 20 fractions is the standard schedule of TSEB in the UK for mycosis fungoides with excellent results but causes significant toxicity. Results of a low dose 12Gy in 8 fractions schedule from 3 centres in the UK were prospectively collected. The results show the complete response rate is lower, the overall response rate and response duration are similar, and the toxicity is less making it an effective option for patients.


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