Low- vs. Middle-dose Total Skin Electron Beam Therapy for Mycosis Fungoides: An Efficiency-based Retrospective Survey of Skin Response
Annelies Taverniers, Aurélie Du-Thanh, Marie Charissoux, Christine Kerr, Olivier Dereure
Preview of fully accepted paper, still not published in any volume
Optimal doses of total skin electron beam therapy for mycosis fungoides remain to be established. Clinical efficiency and adverse effects of middle-dose (25 Gy) vs. low-dose (10–12 Gy) total skin electron beam therapy were retrospectively compared in a series of 14 and 12 mycosis fungoides, respectively. Overall skin response rate was 96.2% (92.9% middle-dose and 100% low-dose; not significant (NS)). Overall complete and partial skin response rates were 57.7% (42.9% middle-dose and 75% low-dose; NS) and 38.5% (50% middle-dose and 25% low-dose; NS), respectively. All responding patients relapsed after an overall median time of 5 months (7 months middle-dose vs. 4 months low-dose; p = 0.164, NS). Tolerance was equally fair in both groups, with only grade 1 and 2 adverse events observed in 100% vs. 66.7% of patients in middle-dose and low-dose groups (NS). Although no significant difference was observed, middle-dose protocol may be recommended owing to a longer relapse-free survival for a similar tolerance.
Mycosis fungoides, the most frequent primary cutaneous lymphoma, can be treated with total skin electron beam therapy, usually advocated as a second- or third-line treatment. However, the optimum dose protocol remains to be established. This study indirectly compared 2 dosages (low- and middle-dose) in a retrospective series. A response was obtained in almost all patients regardless of the dosage, but all responding patients relapsed after a relatively short delay. Tolerance was fair for both protocols. As relapse-free survival was almost twice as long in the middle-dose protocol compared with the low-dose, this might be the best choice for management of mycosis fungoides. However, because middle-dose total skin electron beam therapy, unlike low-dose, can be repeated only once during a patient’s disease course, maintenance treatment should be investigated in this setting.