Total skin electron therapy for cutaneous T-cell lymphoma using a modern
dual-field rotational technique
#MMPMID25670538
Heumann TR
; Esiashvili N
; Parker S
; Switchenko JM
; Dhabbaan A
; Goodman M
; Lechowicz MJ
; Flowers CR
; Khan MK
Int J Radiat Oncol Biol Phys
2015[May]; 92
(1
): 183-91
PMID25670538
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PURPOSE: To report our experience with rotational total skin electron irradiation
(RTSEI) in cutaneous T-cell lymphoma (CTCL), and to examine response by disease
stage and race. METHODS AND MATERIALS: We reviewed our outcomes for 68 CTCL
patients who received RTSEI (? 30 Gy) from 2000 to 2013. Primary outcomes were
complete clinical response (CCR), recurrence-free survival (RFS), and overall
survival (OS). Using log-rank tests and Cox proportional hazards, OS and RFS were
compared across tumor stages at time of RTSEI with further racial subgroup
analysis. RESULTS: Median age at diagnosis and at time of radiation was 52 and 56
years, respectively. Median follow-up was 5.1 years, 49% were African American,
and 49% were female. At time of treatment, 18, 37, and 13 patients were T stage
2, 3, and 4, respectively. At 6 weeks after RTSEI, overall CCR was 82% (88%, 83%,
and 69% for T2, T3, and T4, respectively). Median RFS was 11 months for all
patients and 14, 10, and 12 months for stage T2, T3, and T4, respectively. Tumor
stage was not associated with RFS or CCR. Maintenance therapy after RTSEI was
associated with improved RFS in both crude and multivariable analysis,
controlling for T stage. Median OS was 76 months (91 and 59 months for T3 and T4,
respectively). With the exception of improved OS in African Americans compared
with whites at stage T2, race was not associated with CCR, RFS, or OS.
CONCLUSIONS: These results represent the largest RTSEI clinical outcomes study in
the modern era using a dual-field rotational technique. Our observed response
rates match or improve upon the standard set by previous outcome studies using
conventional TSEI techniques, despite a large percentage of advanced CTCL lesions
in our cohort. We found that clinical response after RTSEI did not seem to be
affected by T stage or race.
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