title: Total Skin Electron Beam for Primary Cutaneous T-cell Lymphoma.
abstract: OBJECTIVE
  Recent trials with low-dose total skin electron beam (TSEB) therapy demonstrated encouraging results for treating primary cutaneous T-cell lymphoma (PCTCL). In this study, we assessed the feasibility of different radiation doses and estimated survival rates of different pathologic entities and stages.
  
  
  METHODS
  We retrospectively identified 45 patients with PCTCL undergoing TSEB therapy between 2000 and 2015. Clinical characteristics, treatment outcomes, and toxicity were assessed.
  
  
  RESULTS
  A total of 49 courses of TSEB therapy were administered to the 45 patients. There were 26 pathologically confirmed cases of mycosis fungoides (MF) lymphoma, 10 cases of Sézary syndrome (SS), and 9 non-MF/SS PCTCL patients. In the MF patients, the overall response rate (ORR) was 92% (50% complete remission [CR]), 70% ORR in SS patients (50% CR), and 89% ORR in non-MF/SS patients (78% CR). The ORR for MF/SS patients treated with conventional dose (30-36 Gy) regimens was 92% (63% CR) and 75% (25% CR) for low-dose (<30-Gy) regimens (P=.09). In MF patients, the overall survival (OS) was 77 months with conventional dose regimens versus 14 months with low-dose regimens (P=.553). In SS patients, the median OS was 48 versus 16 months (P=.219), respectively. Median event-free survival (EFS) for MF in conventional dose patients versus low-dose patients was 15 versus 8 months, respectively (P=.264) and 19 versus 3 months for SS patients (P=.457). Low-dose regimens had shorter treatment time (P=.009) and lower grade 2 adverse events (P=.043). A second TSEB course was administered in 4 MF patients with 100% ORR. There is a possible prognostic impact of supplemental/boost radiation (P<.001); adjuvant treatment (P<.001) and radiation tolerability (P=.021) were detected.
  
  
  CONCLUSIONS
  TSEB therapy is an efficacious treatment modality in the treatment of several forms of cutaneous T-cell lymphoma. There is a nonsignificant trend to higher and longer clinical benefit for MF and SS patients receiving conventional dose. Low-dose TSEB regimens are well tolerated and achieve short-term palliation.
authors.affiliation: Department of Radiation Oncology, University Hospital of Muenster, Muenster, Germany.
authors.forename: Khaled
authors.initials: K
authors.lastname: Elsayad
authors.affiliation: Department of Radiation Oncology, University Hospital of Muenster, Muenster, Germany.
authors.forename: Jan
authors.initials: J
authors.lastname: Kriz
authors.affiliation: Department of Radiation Oncology, University Hospital of Muenster, Muenster, Germany.
authors.forename: Christos
authors.initials: C
authors.lastname: Moustakis
authors.affiliation: Department of Radiation Oncology, University Hospital of Muenster, Muenster, Germany.
authors.forename: Sergiu
authors.initials: S
authors.lastname: Scobioala
authors.affiliation: Department of Radiation Oncology, University Hospital of Muenster, Muenster, Germany.
authors.forename: Gabriele
authors.initials: G
authors.lastname: Reinartz
authors.affiliation: Department of Radiation Oncology, University Hospital of Muenster, Muenster, Germany.
authors.forename: Uwe
authors.initials: U
authors.lastname: Haverkamp
authors.affiliation: Department of Radiation Oncology, University Hospital of Muenster, Muenster, Germany.
authors.forename: Normann
authors.initials: N
authors.lastname: Willich
authors.affiliation: Department of Dermatology, University Hospital of Muenster, Muenster, Germany.
authors.forename: Carsten
authors.initials: C
authors.lastname: Weishaupt
authors.affiliation: Department of Dermatology, Johannes-Wesling-Klinikum Minden, Minden, Germany.
authors.forename: Rudolf
authors.initials: R
authors.lastname: Stadler
authors.affiliation: Department of Dermatology, University Hospital of Muenster, Muenster, Germany.
authors.forename: Cord
authors.initials: C
authors.lastname: Sunderkötter
authors.affiliation: Department of Radiation Oncology, University Hospital of Muenster, Muenster, Germany. Electronic address: Hans.Eich@ukmuenster.de.
authors.forename: Hans Theodor
authors.initials: HT
authors.lastname: Eich
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000704:Analysis of Variance; D018572:Disease-Free Survival; D004583:Electrons / Q000009:adverse effects / Q000627:therapeutic use*; D005240:Feasibility Studies; D005260:Female; D006801:Humans; D016410:Lymphoma, T-Cell, Cutaneous / Q000401:mortality / Q000473:pathology / Q000532:radiotherapy*; D008297:Male; D008875:Middle Aged; D009182:Mycosis Fungoides / Q000401:mortality / Q000473:pathology / Q000532:radiotherapy; D011879:Radiotherapy Dosage; D012189:Retrospective Studies; D012751:Sezary Syndrome / Q000401:mortality / Q000473:pathology / Q000532:radiotherapy; D012878:Skin Neoplasms / Q000401:mortality / Q000473:pathology / Q000532:radiotherapy*