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Low-dose total skin electron beam therapy for cutaneous lymphoma

Minimal risk of acute toxicities

Niedrigdosis-Ganzhautelektronenbestrahlung bei Patienten mit kutanen Lymphomen

Minimales Risiko für akute Toxizitäten

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Abstract

Background

Low-dose total skin electron beam therapy (TSEBT) is attracting increased interest for the effective palliative treatment of primary cutaneous T‑cell lymphoma (pCTCL). In this study, we compared toxicity profiles following various radiation doses.

Patients and methods

We reviewed the records of 60 patients who underwent TSEBT for pCTCL between 2000 and 2016 at the University Hospital of Munster. The treatment characteristics of the radiotherapy (RT) regimens and adverse events (AEs) were then analyzed and compared.

Results

In total, 67 courses of TSEBT were administered to 60 patients. Of these patients, 34 (51%) received a standard dose with a median surface dose of 30 Gy and 33 patients (49%) received a low dose with the median surface dose of 12 Gy (7 salvage low-dose TSEBT courses were administered to 5 patients). After a median follow-up of 15 months, the overall AE rate was 100%, including 38 patients (57%) with grade 2 and 7 (10%) with grade 3 AEs. Patients treated with low-dose TSEBT had significantly fewer grade 2 AEs than those with conventional dose regimens (33 vs. 79%, P < 0.001). A lower grade 3 AE rate was also observed in patients who had received the low-dose regimen compared to those with the conventional dose regimens (6 vs. 15%, P = 0.78). Multiple/salvage low-dose TSEBT courses were not associated with an increased risk of acute AEs.

Conclusion

Low-dose TSEBT regimens are associated with significantly fewer grade 2 acute toxicities compared with conventional doses of TSEBT. Repeated/Salvage low-dose TSEBT, however, appears to be tolerable and can even be applied safely in patients with cutaneous relapses.

Zusammenfassung

Fragestellung

Eine niedrigdosierte Ganzhautelektronenbestrahlung (TSEBT) wird vermehrt zur effektiven palliativen Behandlung von Patienten mit primär kutanen T‑Zell-Lymphomen (pCTCL) eingesetzt. In dieser Studie vergleichen wir die Toxizitätsprofile verschiedener Dosiskonzepte.

Patienten und Methoden

Untersucht wurden 60 zwischen 2000 und 2016 am Universitätsklinikum Münster mittels TSEBT behandelte pCTCL-Patienten. Der Behandlungsablauf und unerwünschte Ereignisse (AEs) bezogen auf die verschiedenen Dosiskonzepte wurden ausgewertet und verglichen.

Ergebnisse

Bei 60 Patienten wurden insgesamt 67 Bestrahlungsserien durchgeführt. Insgesamt 34 Patienten (51 %) bekamen eine Standarddosis mit einer medianen Oberflächendosis von 30 Gy und 33 (49 %) eine Niedrigdosis-TSEBT mit einer medianen Oberflächendosis von 12 Gy (insgesamt wurden 7 niedrigdosierte Salvage-TSEBTs bei 5 Patienten durchgeführt). Bei einer medianen Nachbeobachtungszeit von 15 Monaten betrug die Gesamtwahrscheinlichkeit für AEs 100 %, darunter 38 Patienten (57 %) mit Grad-2- und 7 Patienten (10 %) mit Grad-3-AEs. Patienten, die mit einer niedrigen Dosis behandelt wurden, zeigten signifikant weniger Grad-2-AEs im Vergleich zur Standarddosis (33 vs. 79 %; P < 0,001). Der Niedrigdosis-Arm zeigte weiterhin weniger Grad-3-AEs im Vergleich zur Standarddosis, jedoch ohne Signifikanz (6 vs. 15 %; P = 0,78). Bei niedrigdosierter multipler/Salvage-TSEBT trat keine Häufung von akuten AEs auf.

Schlussfolgerung

Eine Niedrigdosis-TSEBT führt zu signifikant weniger Grad-2-Toxizitäten im Vergleich zur TSEBT in Standarddosis. Eine niedrigdosierte Salvage-TSEBT scheint nicht mit vermehrten Nebenwirkungen verbunden zu sein und eine sichere Therapieform bei kutanen Rezidiven darzustellen.

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Authors and Affiliations

  1. Department of Radiation Oncology, University Hospital of Muenster, Albert-Schweitzer-Straße 33 (Albert-Schweitzer-Campus 1, Building A1), 48149, Muenster, Germany

    Kai Kroeger, Khaled Elsayad MD, Christos Moustakis, Uwe Haverkamp & Hans Theodor Eich

Authors
  1. Kai Kroeger
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  2. Khaled Elsayad MD
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  3. Christos Moustakis
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  4. Uwe Haverkamp
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  5. Hans Theodor Eich
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Corresponding author

Correspondence to Khaled Elsayad MD.

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Conflict of interest

K. Kroeger, K. Elsayad, C. Moustakis, U. Haverkamp, and H.T. Eich declare that they have no competing interests.

Ethical standards

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. Informed consent was obtained from all individual participants included in the study. Additional informed consent was obtained from all individual participants from whom identifying information is included in this article.

Additional information

K. Kroeger and K. Elsayad contributed equally to this work.

This study has been presented at the Annual Meeting of the German Society for Radiation Oncology, Berlin, Germany, June 15–18, 2017 and will be presented at the 59th Annual Meeting of the American Society for Therapeutic Radiology and Oncology, San Diego, September 24–27, 2017.

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Kroeger, K., Elsayad, K., Moustakis, C. et al. Low-dose total skin electron beam therapy for cutaneous lymphoma. Strahlenther Onkol 193, 1024–1030 (2017). https://doi.org/10.1007/s00066-017-1188-8

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  • DOI: https://doi.org/10.1007/s00066-017-1188-8

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