TSEI in patients with mycosis fungoides – clinical results

Česká verzia

Authors: M. Dolečková; A. Chourová; D. Králová; P. Berkovský
Authors place of work: Onkologické oddělení, Nemocnice České Budějovice, a. s.
Published in the journal: Klin Onkol 2020; 33(Suppl 1): 65-79
Category: Original Articles
doi: https://doi.org/10.14735/amko2020S65

Summary

Background: Total skin electron irradiation (TSEI) therapy is a complex method for delivering superficial irradiation to entire skin surface for patients with cutaneous T-cell lymphoma, especially with mycosis fungoides (MF). The purpose of this report is to describe the method and evaluate short- and long-term clinical results of TSEI.

Patients and methods: At the Department of Oncology, Regional Hospital České Budějovice, 88 patients were treated with TSEI in the years 1993–2020. In the group of patients, there were 62 males (70%) and 26 females (30%), the average age was 62 (34–85) years, histology: MF: N = 83 (94%), cutaneous T-cell lymphoma N = 2, leukemia N = 3. TNMB (tumor, node, metastasis, blood): stage I: N = 13 (15.3%), stage II: N = 49 (57.7%), stage III: N = 16 (18.8%), stage IV N = 7 (8.2%). We modified the TSEI technique developed at McGill University, Montreal [1], for our conditions. The daily dose is 2 Gy, i.e. 10 Gy/week; the planned total dose is 30–36 Gy. The patient is in a “ballet dancer” position and rotates on the carrousel at 4 turn/min. Two compound fields produce a uniform dose distribution over the total patient height at the source skin distance 355 cm, with the electron energy 6 MeV. The treatment time is 4 + 4 min. The majority of patients (86%) received rotatory TSEI; only elderly and weak patients underwent a static technique (14%).

Results: Following TSEI with doses > 30 Gy, a 100% complete response was achieved. The overall survival for 85 patients in 5 and 10 years was 53.5% and 26.8%, respectively. The overall survival for stage I was 79.2 and 42.5%, for stage II – 61.2 and 33.6%, for stage III – 13.4 and 0% and for stage IV – 68.6 and 0%. The cause specific survival: 25 patients (28.4%) died of MF. “Week timing”, i.e. prolongation of the overall time for TSEI, brings an important reduction of early TSEI side effects (by 70–80%).

Conclusion: TSEI is efficient and well tolerated in patients with MF. All our patients had benefit from TSEI. Some of them achieved long time remission and some of them received good palliation treatment. The quality of life was improved in all cases.

Keywords:

radiotherapy – mycosis fungoides – clinical results

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