title: Revisiting low-dose total skin electron beam therapy in mycosis fungoides.
abstract: OBJECTIVE
  Total skin electron beam therapy (TSEBT) is a highly effective treatment for mycosis fungoides (MF). The standard course consists of 30 to 36 Gy delivered over an 8- to 10-week period. This regimen is time intensive and associated with significant treatment-related toxicities including erythema, desquamation, anhydrosis, alopecia, and xerosis. The aim of this study was to identify a lower dose alternative while retaining a favorable efficacy profile.
  
  
  METHODS
  One hundred two MF patients were identified who had been treated with an initial course of low-dose TSEBT (5-<30 Gy) between 1958 and 1995. Patients had a T stage classification of T2 (generalized patch/plaque, n = 51), T3 (tumor, n = 29), and T4 (erythrodermic, n = 22). Those with extracutaneous disease were excluded.
  
  
  RESULTS
  Overall response (OR) rates (>50% improvement) were 90% among patients with T2 to T4 disease receiving 5 to <10 Gy (n = 19). In comparison, OR rates between the 10 to <20 Gy and 20 to <30 Gy subgroups were 98% and 97%, respectively. There was no significant difference in median progression free survival (PFS) in T2 and T3 patients when stratified by dose group, and PFS in each was comparable to that of the standard dose.
  
  
  CONCLUSIONS
  OR rates associated with low-dose TSEBT in the ranges of 10 to <20 Gy and 20 to <30 Gy are comparable to that of the standard dose (≥ 30 Gy). Efficacy measures including OS, PFS, and RFS are also favorable. Given that the efficacy profile is similar between 10 and <20 Gy and 20 and <30 Gy, the utility of TSEBT within the lower dose range of 10 to <20 Gy merits further investigation, especially in the context of combined modality treatment.
authors.affiliation: Department of Dermatology, Stanford Cancer Center, Stanford, California 94063, USA. cameronh@stanford.edu
authors.forename: Cameron
authors.initials: C
authors.lastname: Harrison
authors.forename: James
authors.initials: J
authors.lastname: Young
authors.forename: Daniel
authors.initials: D
authors.lastname: Navi
authors.forename: Nadeem
authors.initials: N
authors.lastname: Riaz
authors.forename: Bharathi
authors.initials: B
authors.lastname: Lingala
authors.forename: Youn
authors.initials: Y
authors.lastname: Kim
authors.forename: Richard
authors.initials: R
authors.lastname: Hoppe
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D018572:Disease-Free Survival; D004583:Electrons / Q000627:therapeutic use*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009182:Mycosis Fungoides / Q000401:mortality / Q000473:pathology / Q000532:radiotherapy*; D009364:Neoplasm Recurrence, Local / Q000401:mortality; D011879:Radiotherapy Dosage; D012189:Retrospective Studies; D012878:Skin Neoplasms / Q000401:mortality / Q000473:pathology / Q000532:radiotherapy*; D055815:Young Adult