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Open AccessArticle

Lack of Durable Remission with Conventional-Dose Total Skin Electron Therapy for the Management of Sezary Syndrome and Multiply Relapsed Mycosis Fungoides

1
Department of Radiation Oncology, Peter MacCallum Cancer Centre, Melbourne 3000, Victoria, Australia
2
Department of Clinical Pathology, The University of Melbourne, Parkville 3010, Victoria, Australia
3
Department of Surgical Oncology, Peter MacCallum Cancer Centre, Melbourne 3000, Victoria, Australia
4
Department of Dermatology, St Vincent’s Hospital Melbourne, Fitzroy 3065, Victoria, Australia
5
Melbourne Clinical School, School of Medicine, University of Notre Dame, Werribee 3030, Victoria, Australia
6
Centre for Biostatics and Clinical Trials, Peter MacCallum Cancer Centre, Melbourne 3000, Victoria, Australia
7
Department of Clinical Haematology, Peter MacCallum Cancer Centre and Royal Melbourne Hospital, Melbourne 3000, Victoria, Australia
8
Sir Peter MacCallum Department of Oncology, The University of Melbourne, Parkville 3010, Victoria, Australia
*
Author to whom correspondence should be addressed.
Cancers 2019, 11(11), 1758; https://doi.org/10.3390/cancers11111758
Received: 22 September 2019 / Revised: 31 October 2019 / Accepted: 2 November 2019 / Published: 8 November 2019
Mycosis fungoides (MF) and Sezary syndrome (SS) are multi-relapsing, morbid, cutaneous T-cell lymphomas. Optimal treatment sequencing remains undefined. Total skin electron therapy (TSE) is a highly technical, skin-directed treatment, uniquely producing symptom-free and treatment-free intervals. Recent publications favour low-dose TSE for reduced toxicity, but early data support conventional-dose TSE (cdTSE) for longer disease control. Patient selection requires weighing-up tolerability against response durability. We investigated duration of benefit from cdTSE in patients with poorer prognosis diseases: SS and heavily pre-treated MF. Endpoints were overall survival, and “time to next treatment” (TTNT) as surrogate for clinical benefit duration. Seventy patients (53 MF, 17 SS) were eligible: median prior treatments, 4; median cdTSE dose, 30 Gy; median follow-up, 5.8 years. SS patients had worse prognosis (HR = 5.0, p < 0.001) and shorter TTNT (HR = 4.5, p < 0.001) than MF patients; median TTNT was only 3.7 months. Heavily pre-treated MF patients had inferior prognosis (HR = 1.19 per additional line, p = 0.005), and shorter TTNT (HR = 1.13 per additional line, p = 0.031). Median TTNT for MF patients with ≥3 prior treatments was 7.1 months, versus 23.2 months for 0–2 prior treatments. In conclusion, cdTSE has a limited role in SS. TTNT is reduced in heavily pre-treated MF patients, suggesting greater benefit when utilized earlier in treatment sequencing. View Full-Text
Keywords: total skin electron therapy; cutaneous T-cell lymphoma; mycosis fungoides; Sezary syndrome; skin-directed therapy total skin electron therapy; cutaneous T-cell lymphoma; mycosis fungoides; Sezary syndrome; skin-directed therapy
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Campbell, B.A.; Ryan, G.; McCormack, C.; Tangas, E.; Bressel, M.; Twigger, R.; Buelens, O.; van der Weyden, C.; Prince, H.M. Lack of Durable Remission with Conventional-Dose Total Skin Electron Therapy for the Management of Sezary Syndrome and Multiply Relapsed Mycosis Fungoides. Cancers 2019, 11, 1758.

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