Does adjuvant alpha-interferon improve outcome when combined with total skin irradiation for mycosis fungoides?
BACKGROUND
Patients with mycosis fungoides (MF) experience frequent disease recurrences following total skin electron irradiation (TSEI) and may benefit from adjuvant therapy.


OBJECTIVE
To review the McGill experience with adjuvant alpha-interferon (IFN) in the treatment of MF.


METHODS
From 1990 to 2000, 50 patients with MF were treated with TSEI: 31 with TSEI alone and 19 with TSEI + IFN. Median TSEI dose was 35 Gy. In the TSEI + IFN group, IFN was given subcutaneously at 3 x 10(6) units three times per week starting 2 weeks prior to start of TSEI, continued concurrently with the radiation and for an additional 12 months following TSEI. The TSEI alone group included 16 men and 15 women with a median age of 61 years (range 31-84). The TSEI + IFN group included 14 men and five women with a median age of 51 years (range 24-83). Clinical stage was IA, IB, IIA, IIB, III and IVA in 2, 9, 4, 8, 1 and 7 patients of the TSEI group and 0, 3, 3, 7, 4 and 2 patients of the TSEI + IFN group.


RESULTS
Median follow up for living patients was 70 months. All patients responded to treatment. Complete response (CR) rate was 65% following TSEI and 58% following TSEI + IFN (P = 0.6). Median overall survival (OS) was 61 months following TSEI and 38 months following TSEI + IFN (P = 0.4). Acute grade II-III dermatitis was seen in all patients. Fever, chills or myalgia were seen in 32% of patients treated with TSEI + IFN.


CONCLUSIONS
Concurrent IFN and TSEI is feasible, with acceptable toxicity. Even when controlling for disease stage, the addition of IFN did not appear to increase CR rate, disease-free survival or OS.
Roberge
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D
Department of Radiation Oncology and Division of Hematology, Department of Medicine, McGill University Health Centre, Montreal, Quebec H3G 1A4, Canada. david.roberge@muhc.mcgill.ca
Muanza
T
T
Blake
G
G
Shustik
C
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Vuong
T
T
Freeman
C R
CR
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000970:Antineoplastic Agents / Q000627:therapeutic use*; D017024:Chemotherapy, Adjuvant / Q000379:methods; D015331:Cohort Studies; D003131:Combined Modality Therapy / Q000379:methods; D018572:Disease-Free Survival; D003875:Drug Eruptions / Q000209:etiology; D005260:Female; D006801:Humans; D007370:Interferon Type I / Q000627:therapeutic use*; D008297:Male; D008875:Middle Aged; D009182:Mycosis Fungoides / Q000188:drug therapy* / Q000532:radiotherapy*; D009364:Neoplasm Recurrence, Local; D011994:Recombinant Proteins; D012189:Retrospective Studies; D012878:Skin Neoplasms / Q000188:drug therapy* / Q000532:radiotherapy*; D016896:Treatment Outcome
D000970:Antineoplastic Agents; D007370:Interferon Type I; D011994:Recombinant Proteins