key: cord-0015016-qzhbftba
authors: Rolf, Daniel; Elsayad, Khaled; Eich, Hans Theodor
title: Ultra-hypofractionated low-dose total skin electron beam followed by maintenance therapy: Preliminary findings from a prospective open-label study
date: 2020-11-30
journal: J Am Acad Dermatol
DOI: 10.1016/j.jaad.2020.11.058
sha: d8cb910361455c9a66963e05ec89aba7f1281171
doc_id: 15016
cord_uid: qzhbftba

nan

Ultra-hypofractionated low-dose total skin electron beam followed by maintenance therapy: Preliminary findings from a prospective open-label study

To the Editor: low-dose total skin electron beam therapy (LD-TSEBT) with 12 Gy in 8 fractions is a reasonable approach for mycosis fungoides (MF) and Sezary syndrome (SS). 1 Prior studies show that LD-TSEBT improves cutaneous manifestations and health-related quality of life (HRQL). 2,3 Hypofractionated TSEBT regimens seem to be a feasible alternative to conventional fractionation. 4 Accordingly, the International Lymphoma Radiation Oncology Group recommends ultra-hypofractionated LD-TSEBT as a compelling option during the COVID-19 pandemic to decrease therapy duration and any possible exposure to COVID-19. 5 In this prospective study, we present the feasibility of ultra-hypofractionated LD-TSEBT. Seven radiation courses were administered to 7 patients with MF/SS at our radiation oncology department at the university hospital M€ unster during the initial phase of COVID-19 pandemic from April to July 2020 (Table I) . Patients underwent TSEBT with two 4 Gy fractions. Patients with thicker tumors or pathologically enlarged lymph nodes at the treatment time received additional focal radiotherapy. Treatment characteristics, modified skin-weighted severity (mSWAT), Skindex-29 questionnaire, and toxicity profiles were analyzed.

In this cohort study, the median mSWAT score before the LD-TSEBT was 46. Three patients received concomitant oral retinoid therapy. Moreover, all patients received maintenance treatment after irradiation. The median follow-up duration was 28 weeks. All patients experienced a clinical response with a median mSWAT reduction to 13. Among 5 patients with pruritus (median, 7), a substantial benefit was seen 8 weeks after LD-TSEBT, with a median score of 0. A marked decline in the global Skindex-29 score has been observed regarding patients' quality of life after 8 weeks of therapy with a clinically meaningful difference in the symptoms and emotional subscales.

During ultra-hypofractionated LD-TSEBT, all of the patients encountered mild toxicities (Table I) .

Four patients had grade 1 toxicities, whereas three patients exhibited grade 2 toxicities. The most common adverse effects were erythema, followed by edema. One patient, who had a thick ulcerated lesion, had sepsis during the treatment course and was successfully treated with antibiotics. After 8 weeks, all grade 2 adverse events were resolved. No patients had grade 4 to 5 adverse events.

In this research letter, we report the acute and subacute toxicities after LD-TSEBT with two 4-Gy fractions. Long-term outcome and toxicities need to be investigated in a subsequent report.

Our preliminary results showed that ultra-hypofractionated LD-TSEBT is a safe and feasible alternative to conventionally fractionated TSEBT for patients with MF/SS to reduce the overall therapy duration and possible COVID-19 exposure. The mSWAT scores and the HRQL recovered after ultra-hypofractionated LD-TSEBT. A detailed HRQL analysis using several instruments and the possible role of oral retinoids as a maintenance treatment after TSEBT are under development by our cutaneous lymphoma group and is supposed to help clinicians find the suitable fractionation regimen and maintenance therapies for MF/SS patients. 

n 2020

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A prospective cohort study of condensed low-dose total skin electron beam therapy for mycosis fungoides: reduction of disease burden and improvement in quality of life

Low-dose hypofractionated total skin electron beam therapy for adult cutaneous T-cell lymphoma

ILROG Emergency guidelines for radiation therapy of hematological malignancies during the COVID-19 pandemic