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Low-Dose Hypofractionated Total Skin Electron Beam Therapy for Adult Cutaneous T-Cell Lymphoma

PURPOSE: Historically, the standard of care for total skin electron beam therapy (TSEBT) delivered 30 to 36 Gy over 5 to 10 weeks. Given the high risk of relapse, a majority of patients require additional treatments. Therefore, attempts to use a shortened course of TSEBT have been investigated. METH...

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Autores principales: Jeans, Elizabeth B., Hu, Yue-Houng, Stish, Bradley J., King, Brian, Davis, Mark, Harmsen, William S., Fruth, Kristin M., Locher, Sarah E., Deufel, Christopher L., Evans, Jaden D., Martenson, James A., Lester, Scott C.
Formato: Online Artículo Texto
Lenguaje:English
Publicado: The Author(s). Published by Elsevier Inc. on behalf of American Society for Radiation Oncology. 2020
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7414776/
https://www.ncbi.nlm.nih.gov/pubmed/32781247
http://dx.doi.org/10.1016/j.prro.2020.08.001
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author Jeans, Elizabeth B.
Hu, Yue-Houng
Stish, Bradley J.
King, Brian
Davis, Mark
Harmsen, William S.
Fruth, Kristin M.
Locher, Sarah E.
Deufel, Christopher L.
Evans, Jaden D.
Martenson, James A.
Lester, Scott C.
author_facet Jeans, Elizabeth B.
Hu, Yue-Houng
Stish, Bradley J.
King, Brian
Davis, Mark
Harmsen, William S.
Fruth, Kristin M.
Locher, Sarah E.
Deufel, Christopher L.
Evans, Jaden D.
Martenson, James A.
Lester, Scott C.
author_sort Jeans, Elizabeth B.
collection PubMed
description PURPOSE: Historically, the standard of care for total skin electron beam therapy (TSEBT) delivered 30 to 36 Gy over 5 to 10 weeks. Given the high risk of relapse, a majority of patients require additional treatments. Therefore, attempts to use a shortened course of TSEBT have been investigated. METHODS AND MATERIALS: We conducted a single-institution retrospective review to evaluate disease response, control, and toxicity using a low-dose, hypofractionated course of TSEBT (HTSEBT) in patients with mycosis fungoides. RESULTS: Forty patients received 57 courses of HTSEBT. Median dose (Gy)/fractionation was 12/3, spanning a median time of 2.4 weeks. Overall response rate of patients assessed (n = 54) was 100%. Thirty-one courses (57.4%) resulted in a complete response and 23 courses (42.6%) resulted in a partial response. Cumulative incidence of progressive skin disease at 3 months was 37.2%, at 6 months, 56.9%, and at 1 year, 81.5%. Of the 40 patients treated with a first course of HTSEBT, 31 received subsequent courses of radiotherapy. Cumulative incidence of subsequent treatment was 28.0% at 3 months, 46.8% at 6 months, and 70.0% at 1 year. Patients who underwent repeat courses of HTSEBT continued to have similar treatment responses to repeat courses without increased toxicities. Toxicities from all courses were acceptable with the exception of 1 patient, who experienced grade 4 skin toxicity (moist desquamation requiring hospitalization). CONCLUSIONS: Low-dose HTSEBT provides good palliation in patients with cutaneous T-cell lymphoma with a satisfactory response and toxicity profile. HTSEBT allows therapy to be completed in far fewer treatments. Low-dose HTSEBT is an appropriate treatment option for patients unable to come for daily treatment. HTSEBT provides a way to decrease exposure to other patients and staff during public health emergencies such as the coronavirus disease 2019 (COVID-19) pandemic.
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spelling pubmed-74147762020-08-10 Low-Dose Hypofractionated Total Skin Electron Beam Therapy for Adult Cutaneous T-Cell Lymphoma Jeans, Elizabeth B. Hu, Yue-Houng Stish, Bradley J. King, Brian Davis, Mark Harmsen, William S. Fruth, Kristin M. Locher, Sarah E. Deufel, Christopher L. Evans, Jaden D. Martenson, James A. Lester, Scott C. Pract Radiat Oncol Basic Original Report PURPOSE: Historically, the standard of care for total skin electron beam therapy (TSEBT) delivered 30 to 36 Gy over 5 to 10 weeks. Given the high risk of relapse, a majority of patients require additional treatments. Therefore, attempts to use a shortened course of TSEBT have been investigated. METHODS AND MATERIALS: We conducted a single-institution retrospective review to evaluate disease response, control, and toxicity using a low-dose, hypofractionated course of TSEBT (HTSEBT) in patients with mycosis fungoides. RESULTS: Forty patients received 57 courses of HTSEBT. Median dose (Gy)/fractionation was 12/3, spanning a median time of 2.4 weeks. Overall response rate of patients assessed (n = 54) was 100%. Thirty-one courses (57.4%) resulted in a complete response and 23 courses (42.6%) resulted in a partial response. Cumulative incidence of progressive skin disease at 3 months was 37.2%, at 6 months, 56.9%, and at 1 year, 81.5%. Of the 40 patients treated with a first course of HTSEBT, 31 received subsequent courses of radiotherapy. Cumulative incidence of subsequent treatment was 28.0% at 3 months, 46.8% at 6 months, and 70.0% at 1 year. Patients who underwent repeat courses of HTSEBT continued to have similar treatment responses to repeat courses without increased toxicities. Toxicities from all courses were acceptable with the exception of 1 patient, who experienced grade 4 skin toxicity (moist desquamation requiring hospitalization). CONCLUSIONS: Low-dose HTSEBT provides good palliation in patients with cutaneous T-cell lymphoma with a satisfactory response and toxicity profile. HTSEBT allows therapy to be completed in far fewer treatments. Low-dose HTSEBT is an appropriate treatment option for patients unable to come for daily treatment. HTSEBT provides a way to decrease exposure to other patients and staff during public health emergencies such as the coronavirus disease 2019 (COVID-19) pandemic. The Author(s). Published by Elsevier Inc. on behalf of American Society for Radiation Oncology. 2020 2020-08-08 /pmc/articles/PMC7414776/ /pubmed/32781247 http://dx.doi.org/10.1016/j.prro.2020.08.001 Text en © 2020 The Author(s) Since January 2020 Elsevier has created a COVID-19 resource centre with free information in English and Mandarin on the novel coronavirus COVID-19. The COVID-19 resource centre is hosted on Elsevier Connect, the company's public news and information website. Elsevier hereby grants permission to make all its COVID-19-related research that is available on the COVID-19 resource centre - including this research content - immediately available in PubMed Central and other publicly funded repositories, such as the WHO COVID database with rights for unrestricted research re-use and analyses in any form or by any means with acknowledgement of the original source. These permissions are granted for free by Elsevier for as long as the COVID-19 resource centre remains active.
spellingShingle Basic Original Report
Jeans, Elizabeth B.
Hu, Yue-Houng
Stish, Bradley J.
King, Brian
Davis, Mark
Harmsen, William S.
Fruth, Kristin M.
Locher, Sarah E.
Deufel, Christopher L.
Evans, Jaden D.
Martenson, James A.
Lester, Scott C.
Low-Dose Hypofractionated Total Skin Electron Beam Therapy for Adult Cutaneous T-Cell Lymphoma
title Low-Dose Hypofractionated Total Skin Electron Beam Therapy for Adult Cutaneous T-Cell Lymphoma
title_full Low-Dose Hypofractionated Total Skin Electron Beam Therapy for Adult Cutaneous T-Cell Lymphoma
title_fullStr Low-Dose Hypofractionated Total Skin Electron Beam Therapy for Adult Cutaneous T-Cell Lymphoma
title_full_unstemmed Low-Dose Hypofractionated Total Skin Electron Beam Therapy for Adult Cutaneous T-Cell Lymphoma
title_short Low-Dose Hypofractionated Total Skin Electron Beam Therapy for Adult Cutaneous T-Cell Lymphoma
title_sort low-dose hypofractionated total skin electron beam therapy for adult cutaneous t-cell lymphoma
topic Basic Original Report
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7414776/
https://www.ncbi.nlm.nih.gov/pubmed/32781247
http://dx.doi.org/10.1016/j.prro.2020.08.001
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