title: Total skin electron therapy for cutaneous T-cell lymphoma using a modern dual-field rotational technique.
abstract: OBJECTIVE
  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
  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.
authors: Emory University School of Medicine, Emory University, Atlanta, Georgia.
authors: Thatcher R
authors: TR
authors: Heumann
authors: Department of Radiation Oncology, Emory University, Atlanta, Georgia; Winship Cancer Institute (WCI), Emory University, Atlanta, Georgia.
authors: Natia
authors: N
authors: Esiashvili
authors: Department of Dermatology, Emory University, Atlanta, Georgia.
authors: Sareeta
authors: S
authors: Parker
authors: Biostatistics Shared Core Resource at WCI, Emory University, Atlanta, Georgia.
authors: Jeffrey M
authors: JM
authors: Switchenko
authors: Department of Radiation Oncology, Emory University, Atlanta, Georgia; Winship Cancer Institute (WCI), Emory University, Atlanta, Georgia.
authors: Anees
authors: A
authors: Dhabbaan
authors: Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, Georgia.
authors: Michael
authors: M
authors: Goodman
authors: Department of Radiation Oncology, Emory University, Atlanta, Georgia; Department of Hematology and Oncology, Emory University, Atlanta, Georgia.
authors: Mary Jo
authors: MJ
authors: Lechowicz
authors: Department of Radiation Oncology, Emory University, Atlanta, Georgia; Department of Hematology and Oncology, Emory University, Atlanta, Georgia.
authors: Christopher R
authors: CR
authors: Flowers
authors: Department of Radiation Oncology, Emory University, Atlanta, Georgia; Winship Cancer Institute (WCI), Emory University, Atlanta, Georgia. Electronic address: drkhurram2000@gmail.com.
authors: Mohammad K
authors: MK
authors: Khan
mesh_terms: D000328:Adult; D001741:Black or African American; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D015331:Cohort Studies; D018572:Disease-Free Survival; D019583:Dose Fractionation, Radiation; D004583:Electrons / Q000627:therapeutic use*; D005260:Female; D006801:Humans; D016410:Lymphoma, T-Cell, Cutaneous / Q000208:ethnology / Q000401:mortality / Q000473:pathology / Q000532:radiotherapy*; D008297:Male; D008875:Middle Aged; D009182:Mycosis Fungoides / Q000208:ethnology / Q000401:mortality / Q000532:radiotherapy; D009367:Neoplasm Staging; D017063:Outcome Assessment, Health Care; D011835:Radiation Protection / Q000295:instrumentation / Q000379:methods; D011878:Radiotherapy / Q000379:methods; D012189:Retrospective Studies; D012878:Skin Neoplasms / Q000208:ethnology / Q000401:mortality / Q000473:pathology / Q000532:radiotherapy*; D016019:Survival Analysis; D044465:White People; D055815:Young Adult