title: Outcome of patients treated with a single-fraction dose of palliative radiation for cutaneous T-cell lymphoma.
abstract: OBJECTIVE
  Cutaneous T-cell lymphoma (CTCL) is a radiosensitive tumor. Presently, treatment with radiation is given in multiple fractions. The current literature lacks data that support single-fraction treatment for CTCL. This retrospective review assesses the clinical response in patients treated with a single fraction of radiation.
  
  
  METHODS
  This study reviewed the records of 58 patients with CTCL, primarily mycosis fungoides, treated with a single fraction of palliative radiation therapy (RT) between October 1991 and January 2011. Patient and tumor characteristics were reviewed. Response rates were compared using Fisher's exact test and multiple logistic regressions. Survival rates were determined using the Kaplan-Meier method. Cost-effectiveness analysis was performed to assess the cost of a single vs a multifractionated treatment regimen.
  
  
  RESULTS
  Two hundred seventy individual lesions were treated, with the majority (97%) treated with ≥ 700 cGy; mean follow-up was 41.3 months (range, 3-180 months). Response rate by lesion was assessed, with a complete response (CR) in 255 (94.4%) lesions, a partial response in 10 (3.7%) lesions, a partial response converted to a CR after a second treatment in 4 (1.5%) lesions, and no response in 1 (0.4%) lesion. The CR in lower extremity lesions was lower than in other sites (P=.0016). Lesions treated with photons had lower CR than those treated with electrons (P=.017). Patients with lesions exhibiting large cell transformation and tumor morphology had lower CR (P=.04 and P=.035, respectively). Immunophenotype did not impact response rate (P=.23). Overall survival was significantly lower for patients with Sézary syndrome (P=.0003) and erythroderma (P<.0001). The cost of multifractionated radiation was >200% higher than that for single-fraction radiation.
  
  
  CONCLUSIONS
  A single fraction of 700 cGy-800 cGy provides excellent palliation for CTCL lesions and is cost effective and convenient for the patient.
authors: Department of Radiation Oncology, Northwestern University, Robert H. Lurie Comprehensive Cancer Center, Chicago, Illinois, USA.
authors: Tarita O
authors: TO
authors: Thomas
authors: Priya
authors: P
authors: Agrawal
authors: Joan
authors: J
authors: Guitart
authors: Steven T
authors: ST
authors: Rosen
authors: Alfred W
authors: AW
authors: Rademaker
authors: Christiane
authors: C
authors: Querfeld
authors: John P
authors: JP
authors: Hayes
authors: Timothy M
authors: TM
authors: Kuzel
authors: Bharat B
authors: BB
authors: Mittal
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003362:Cost-Benefit Analysis; D004583:Electrons / Q000627:therapeutic use; D005260:Female; D006801:Humans; D016015:Logistic Models; D016410:Lymphoma, T-Cell, Cutaneous / Q000401:mortality / Q000473:pathology / Q000532:radiotherapy*; D008297:Male; D008875:Middle Aged; D009182:Mycosis Fungoides / Q000473:pathology / Q000532:radiotherapy; D010166:Palliative Care / Q000191:economics / Q000379:methods; D017785:Photons / Q000627:therapeutic use; D011878:Radiotherapy / Q000191:economics; D012074:Remission Induction; D012189:Retrospective Studies; D012751:Sezary Syndrome / Q000401:mortality / Q000532:radiotherapy; D012878:Skin Neoplasms / Q000401:mortality / Q000473:pathology / Q000532:radiotherapy*; D016896:Treatment Outcome; D055815:Young Adult