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Low-dose total skin electron beam therapy: Quality of life improvement and clinical impact of maintenance and adjuvant treatment in patients with mycosis fungoides or Sezary syndrome

Niedrigdosis-Ganzhautelektronenbestrahlung: Verbesserung der Lebensqualität und klinische Auswirkungen der Erhaltungstherapie bei Patienten mit Mycosis fungoides oder Sézary-Syndrom



Total skin electron beam therapy (TSEBT) has proved to be a safe and effective treatment for cutaneous T‑cell lymphomas. Here, we examined the impact of this treatment on patient quality of life and outcome.

Patients and methods

Forty-four patients with mycosis fungoides (MF) or Sezary syndrome (SS) received 48 TSEBT courses with a median dose of 12 Gy within the past 8 years at our institute. Patient and treatment characteristics for these cases as well as the impact of TSEBT on quality of life and duration of response were retrospectively analyzed and compared.


The median modified Severity-Weighted Assessment Tool score before the start of TSEBT was 44. The overall response rate was 88%, with a complete response (CR) rate of 33%. The median follow-up period was 13 months. The median duration of response (DOR) and progression-free survival (PFS) for the entire cohort were 10 months and 9 months, respectively. Patient-reported symptom burden was measured with the Dermatological Life Quality Index and Skindex-29 questionnaires. The mean symptom reductions were 6 ± 8 (P = 0.005) and 21 ± 24 (P = 0.002), respectively. In the Functional Assessment of Cancer Therapy-General Assessment, significant improvements in the emotional (P = 0.03) domains were observed after TSEBT. Patients who received maintenance or adjuvant treatments had a longer PFS (P = 0.01).


TSEBT improved disease symptoms and significantly improved emotional domains of patients’ quality of life in patients with MF or SS. In addition, our results indicate that maintenance or adjuvant therapy after TSEBT may improve the PFS.



Die Ganzhautelektronenbestrahlung (TSEBT) ist ein sicheres und wirksames Verfahren für kutane T‑Zell-Lymphome. Hier untersuchten wir den Einfluss dieser Behandlung auf die Lebensqualität der Patienten und das Ergebnis.

Patienten und Methoden

Vierundvierzig Patienten mit Mycosis fungoides (MF) oder Sézary-Syndrom (SS) erhielten 48 TSEBT-Durchläufe mit mittlerer Dosis von 12 Gy an unserem Institut. Patienten- und Behandlungscharakteristika für diese Fälle sowie der Einfluss von TSEBT auf die Lebensqualität und Remissionsdauer wurden retrospektiv analysiert und verglichen.


Der mittlere mSWAT-Wert (modified Severity-Weighted Assessment Tool) vor dem Start von TSEB betrug 44. Die Gesamtansprechrate betrug 88%, die Vollremissionsrate (CR) 33%. Die mediane Nachbeobachtungszeit betrug 13 Monate. Die mittlere Ansprechdauer (DOR) und das progressionsfreie Überleben (PFS) für die gesamte Kohorte betrugen jeweils 10 Monate und 9 Monate. Die vom Patienten berichtete Symptombelastung wurde mit dem Dermatological Life Quality Index und Skindex-29-Fragebögen gemessen. Die mittlere Symptomverbesserung betrug 6 ± 8 (P = 0,005) bzw. 21 ± 24 (P = 0,002). Bei der Bewertung der funktionalen Beurteilung der Krebstherapie nach allgemeinen Indikatoren wurden nach TSEBT signifikante Verbesserungen in den emotionalen (P = 0,03) Domänen beobachtet. Patienten, die eine Erhaltungstherapie erhielten, hatten längere PFS (P = 0,01).


Die TSEBT verbesserte die Krankheitssymptome und die emotionalen Bereiche der Lebensqualität von Patienten mit MF oder SS. Darüber hinaus zeigen unsere Ergebnisse, dass die Erhaltungstherapie nach TSEBT die PFS verbessern kann.

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  1. 1.

    Stadler R, Stranzenbach R (2018) Molecular pathogenesis of cutaneous lymphomas. Exp Dermatol 27(10):1078–1083. https://doi.org/10.1111/exd.13701

  2. 2.

    Leuchte K, Schlaak M, Stadler R et al (2017) Innovative treatment concepts for cutaneous T‑cell Lymphoma based on microenvironment modulation. Oncol Res Treat 40(5):262–269. https://doi.org/10.1159/000472257

  3. 3.

    Harrison C, Young J, Navi D et al (2011) Revisiting low-dose total skin electron beam therapy in mycosis fungoides. Int J Radiat Oncol Biol Phys 81(4):e651–e657. https://doi.org/10.1016/j.ijrobp.2011.01.023

  4. 4.

    Hoppe RT, Harrison C, Tavallaee M et al (2015) Low-dose total skin electron beam therapy as an effective modality to reduce disease burden in patients with mycosis fungoides: results of a pooled analysis from 3 phase-II clinical trials. J Am Acad Dermatol 72(2):286–292. https://doi.org/10.1016/j.jaad.2014.10.014

  5. 5.

    Kamstrup MR, Gniadecki R, Iversen L et al (2015) Low-dose (10-Gy) total skin electron beam therapy for cutaneous T‑cell lymphoma: an open clinical study and pooled data analysis. Int J Radiat Oncol Biol Phys 92(1):138–143. https://doi.org/10.1016/j.ijrobp.2015.01.047

  6. 6.

    Elsayad K, Kriz J, Moustakis C et al (2015) Total skin electron beam for primary cutaneous T‑cell lymphoma. Int J Radiat Oncol Biol Phys 93(5):1077–1086. https://doi.org/10.1016/j.ijrobp.2015.08.041

  7. 7.

    Morris S, Scarisbrick J, Frew J et al (2017) The results of low-dose total skin electron beam radiation therapy (TSEB) in patients with mycosis fungoides from the UK cutaneous lymphoma group. Int J Radiat Oncol Biol Phys 99(3):627–633. https://doi.org/10.1016/j.ijrobp.2017.05.052

  8. 8.

    Kroeger K, Elsayad K, Moustakis C et al (2017) Niedrigdosis-Ganzhautelektronenbestrahlung bei Patienten mit kutanen Lymphomen : Minimales Risiko für akute Toxizitäten (Low-dose total skin electron beam therapy for cutaneous lymphoma : Minimal risk of acute toxicities). Strahlenther Onkol 193(12):1024–1030. https://doi.org/10.1007/s00066-017-1188-8

  9. 9.

    Elsayad K, Oertel M, Haverkamp U et al (2017) The effectiveness of radiotherapy for leukemia cutis. J Cancer Res Clin Oncol 143(5):851–859. https://doi.org/10.1007/s00432-016-2338-6

  10. 10.

    Prince HM, Kim YH, Horwitz SM et al (2017) Brentuximab vedotin or physician’s choice in CD30-positive cutaneous T‑cell lymphoma (ALCANZA): an international, open-label, randomised, phase 3, multicentre trial. Lancet 390(10094):555–566. https://doi.org/10.1016/S0140-6736(17)31266-7

  11. 11.

    Khodadoust M, Rook AH, Porcu P et al (2016) Pembrolizumab for treatment of relapsed/refractory mycosis fungoides and sezary syndrome: clinical efficacy in a Citn Multicenter phase 2 study. Blood 128(22):181

  12. 12.

    Jain S, Zain J, O’Connor O (2012) Novel therapeutic agents for cutaneous T‑Cell lymphoma. J Hematol Oncol 5:24. https://doi.org/10.1186/1756-8722-5-24

  13. 13.

    Trautinger F, Eder J, Assaf C et al (2017) European Organisation for Research and Treatment of Cancer consensus recommendations for the treatment of mycosis fungoides/Sezary syndrome—Update 2017. Eur J Cancer 77:57–74. https://doi.org/10.1016/j.ejca.2017.02.027

  14. 14.

    Heumann TR, Esiashvili N, Parker S et al (2015) Total skin electron therapy for cutaneous T‑cell lymphoma using a modern dual-field rotational technique. Int J Radiat Oncol Biol Phys 92(1):183–191. https://doi.org/10.1016/j.ijrobp.2014.11.033

  15. 15.

    Selman LE, Beynon T, Radcliffe E et al (2015) ‘We’re all carrying a burden that we’re not sharing’: a qualitative study of the impact of cutaneous T‑cell lymphoma on the family. Br J Dermatol 172(6):1581–1592. https://doi.org/10.1111/bjd.13583

  16. 16.

    Dippel E, Assaf C, Becker JC et al (2018) S2k guidelines—cutaneous lymphomas update 2016—part 2: treatment and follow-up (ICD10 C82—C86). J Dtsch Dermatol Ges 16(1):112–122. https://doi.org/10.1111/ddg.13401

  17. 17.

    Molloy K, Evison F, Peng C et al (2018) Quality of life in patients with mycosis fungoides and Sezary syndrome is significantly worse in female patients, Sézary syndrome and those with more extensive skin involvement. Eur J Cancer 101:S39. https://doi.org/10.1016/j.ejca .2018.07.310

  18. 18.

    Finlay AY, Khan GK (1994) Dermatology Life Quality Index (DLQI)— a simple practical measure for routine clinical use. Clin Exp Dermatol 19(3):210–216

  19. 19.

    Chren MM, Lasek RJ, Quinn LM et al (1996) Skindex, a quality-of-life measure for patients with skin disease: reliability, validity, and responsiveness. J Invest Dermatol 107(5):707–713

  20. 20.

    Yost KJ, Thompson CA, Eton DT et al (2012) The Functional Assessment of Cancer Therapy—General (FACT-G) is valid for monitoring quality of life in non-Hodgkin lymphoma patients. Leuk Lymphoma 54(2):290–297. https://doi.org/10.3109/10428194.2012.711830

  21. 21.

    Olsen EA, Whittaker S, Kim YH et al (2011) Clinical end points and response criteria in mycosis fungoides and Sezary syndrome: a consensus statement of the International Society for Cutaneous Lymphomas, the United States Cutaneous Lymphoma Consortium, and the Cutaneous Lymphoma task force of the European Organisation for Research and Treatment of Cancer. J Clin Oncol 29(18):2598–2607. https://doi.org/10.1200/JCO.2010.32.0630

  22. 22.

    Elsayad K, Moustakis C, Simonsen M et al (2018) In-vivo dosimetric analysis in total skin electron beam therapy. Phys Imaging Radiat Oncol 6:61–65. https://doi.org/10.1016/j.phro.2018.05.002

  23. 23.

    Elsayad K, Susek KH, Eich HT (2017) Total skin electron beam therapy as part of multimodal treatment strategies for primary cutaneous T‑cell lymphoma. Oncol Res Treat 40(5):244–252. https://doi.org/10.1159/000475634

  24. 24.

    Simontacchi G, Lo Russo M, Marrazzo L et al (2018) Low dose total skin irradiation followed by maintenance with oral bexarotene in mycosis fungoides. Radiother Oncol 127:376–S376

  25. 25.

    Ko EC, Formenti SC (2018) Radiotherapy and checkpoint inhibitors: a winning new combination? Ther Adv Med Oncol 10:1758835918768240. https://doi.org/10.1177/1758835918768240

  26. 26.

    An Y, Jiang W, Andraos TY et al (2019) Multi-institutional Investigation: circulating CD4:CD8 ratio is a prognosticator of response to total skin electron beam radiation in mycosis fungoides. Radiother Oncol 131:88–92. https://doi.org/10.1016/j.radonc.2018.12.003

  27. 27.

    Lesokhin AM, Ansell SM, Armand P et al (2016) Nivolumab in patients with relapsed or refractory hematologic malignancy: preliminary results of a phase Ib study. J Clin Oncol 34(23):2698–2704. https://doi.org/10.1200/JCO.2015.65.9789

  28. 28.

    Khodadoust MS, Rook AH, Porcu P et al (2018) Pembrolizumab in mycosis fungoides and Sézary syndrome: updated results of the CITN multicenter Phase 2 study. Eur J Cancer 101:S37. https://doi.org/10.1016/j.ejca .2018.07.304

  29. 29.

    Battistella M, Janin A, Jean-Louis F et al (2016) KIR3DL2 (CD158k) is a potential therapeutic target in primary cutaneous anaplastic large-cell lymphoma. Br J Dermatol 175(2):325–333. https://doi.org/10.1111/bjd.14626

  30. 30.

    Bagot M, Porcu P, Marie-Cardine A, Battistella M, William BM, Vermeer M et al (2019) IPH4102, a first-in-class anti-KIR3DL2 monoclonal antibody, in patients with relapsed or refractory cutaneous T‑cell lymphoma: an international, first-in-human, open-label, phase 1 trial. Lancet Oncol 20(8):1160–1170

  31. 31.

    Kim YH, Bagot M, Pinter-Brown L et al (2018) Mogamulizumab versus vorinostat in previously treated cutaneous T‑cell lymphoma (MAVORIC): an international, open-label, randomised, controlled phase 3 trial. Lancet Oncol 19(9):1192–1204. https://doi.org/10.1016/S1470-2045(18)30379-6

  32. 32.

    Rückert M, Deloch L, Fietkau R et al (2018) Immunmodulierende Eigenschaften von Radiotherapie als Basis für wohldurchdachte Radioimmuntherapien (Immune modulatory effects of radiotherapy as basis for well-reasoned radioimmunotherapies). Strahlenther Onkol 194(6):509–519. https://doi.org/10.1007/s00066-018-1287-1

  33. 33.

    Dabaja B (2017) Renaissance of low-dose radiotherapy concepts for cutaneous lymphomas. Oncol Res Treat 40(5):255–260. https://doi.org/10.1159/000470845

  34. 34.

    Moritz RKC, Ditschkowski M, Klemke C‑D et al (2014) Allogeneic stem cell transplantation in patients with aggressive primary cutaneous T‑cell lymphoma—a case series of the ADF working group “cutaneous lymphomas”. J Dtsch Dermatol Ges 12(1):39–46. https://doi.org/10.1111/ddg.12212

  35. 35.

    Polansky M, Talpur R, Daulat S et al (2015) Long-term complete responses to combination therapies and allogeneic stem cell transplants in patients with Sezary syndrome. Clin Lymphoma Myeloma Leuk 15(5):e83–e93. https://doi.org/10.1016/j.clml.2014.09.013

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Author information

KE was involved in formal analysis, research methodology, and first manuscript drafting. All co-authors were involved in conceptualization of the manuscript, manuscript drafting, and editing. HTE was the senior author who oversaw the project. All co-authors read and approved the final manuscript.

Correspondence to Dr. Khaled Elsayad MD.

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Conflict of interest

K. Elsayad, K. Kroeger, B. Greve, C. Moustakis, C. Assaf, R. Stadler, G. Lenz, C. Weishaupt, and H.T. Eich declare that they have no competing interests.

Ethical standards

Ethics approval and consent to participate: patients signed consent prior to treatment being initiated and data being collected. Consent for publication: patients signed consent prior to treatment being initiated and data being collected. Ethical approval: All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. For this type of study, formal consent is not required.

Additional information

This study was presented at the Annual Meeting of the German Society for Radiation Oncology, Münster, Germany, June 13–16, 2019 and at the Annual Meeting of the American Society for Therapeutic Radiology and Oncology, Chicago, September 15–18, 2019 (Oral presentations).

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Please contact Khaled Elsayad for data requests.

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Elsayad, K., Kroeger, K., Greve, B. et al. Low-dose total skin electron beam therapy: Quality of life improvement and clinical impact of maintenance and adjuvant treatment in patients with mycosis fungoides or Sezary syndrome. Strahlenther Onkol 196, 77–84 (2020). https://doi.org/10.1007/s00066-019-01517-7

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  • Cutaneous lymphoma
  • Itching
  • Quality of life
  • Maintenance therapy
  • Immunity


  • Hautlymphom
  • Juckreiz
  • Lebensqualität
  • Erhaltungstherapie
  • Immunity