Total skin electron beam for primary cutaneous T-cell lymphoma
Mené auprès de 45 patients atteints d'un lymphome cutané primitif à cellules T traité entre 2000 et 2015, cette étude évalue la faisabilité d'une radiothérapie par faisceaux d'électrons délivrant de faibles doses de rayonnements ionisants sur la totalité de la peau
Objectives : Recent trials with low-dose total skin electron beam therapy (TSEB) demonstrated encouraging results of treating primary cutaneous T-cell lymphoma (PCTCL). In this study we assess the feasibility of different radiation doses, and estimate survival rates of different pathologic entities and stages. Materials and Methods : We retrospectively identified 45 patients with PCTCL undergoing TSEB between 2000 and 2015. The clinical characteristics, treatment outcomes, and toxicity were assessed. Results : 49 courses of TSEB were administered to the 45 patients. There were 26 pathologically-confirmed Mycosis fungoides (MF), 10 Sézary Syndrome (SS) and 9 non-MF/SS CTCL. In the MF patients, the overall response rate (ORR) was 92% and the complete remission rate (CR) was 50%, in SS 70% (50% CR) and in the non-MF/SS patients 89% (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=0.09). In MF patients, the overall survival (OS) was 77 months with conventional-dose regimens vs. 14 months with low-dose regimens (p=0.553). In SS patients, the median OS was 48 vs. 16 months (p=0.219), respectively. The median event-free survival (EFS) for MF in conventional-dose patients vs. low-dose patients was 15 vs. 8 months (p=0.264) and for SS, 19 vs. 3 months (p=0.457). Low-dose regimens had shorter treatment time (p=0.009) and lower grade 2 AEs (p=0.043). A second TSEB course was administered in 4 MF patients with 100% ORR. There is a possible prognostic impact of supplemental/boost radiation (p<0.001); adjuvant treatment (p<0.001) and radiation tolerability (p=0.021) has been detected. Conclusion : TSEB is an efficacious treatment modality in several forms of cutaneous T-cell lymphoma. There is a non-significant 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.