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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

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Abstract

Purpose

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.

Results

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).

Conclusion

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.

Zusammenfassung

Fragestellung

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.

Ergebnisse

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).

Schlussfolgerung

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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Authors and Affiliations

Authors

Contributions

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.

Corresponding author

Correspondence to 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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