PURPOSE: Historically, the standard of care for total skin electron beam therapy (TSEBT) delivered 30 to 36 Gy over 5 to 10 weeks . Given the high risk of relapse, a majority of patients require additional treatments . Therefore, attempts to use a shortened course of TSEBT have been investigated .
METHODS AND MATERIALS: We conducted a single-institution retrospective review to evaluate disease response, control, and toxicity using a low-dose, hypofractionated course of TSEBT (HTSEBT) in patients with mycosis fungoides .
RESULTS: Forty patients received 57 courses of HTSEBT . Median dose (Gy) /fractionation was 12/3, spanning a median time of 2.4 weeks . Overall response rate of patients assessed (n = 54) was 100% . Thirty-one courses (57.4 %) resulted in a complete response and 23 courses (42.6 %) resulted in a partial response . Cumulative incidence of progressive skin disease at 3 months was 37.2%, at 6 months , 56.9%, and at 1 year , 81.5% . Of the 40 patients treated with a first course of HTSEBT, 31 received subsequent courses of radiotherapy . Cumulative incidence of subsequent treatment was 28.0% at 3 months , 46.8% at 6 months, and 70.0% at 1 year . Patients who underwent repeat courses of HTSEBT continued to have similar treatment responses to repeat courses without increased toxicities . Toxicities from all courses were acceptable with the exception of 1 patient, who experienced grade 4 skin toxicity (moist desquamation requiring hospitalization).
CONCLUSIONS: Low-dose HTSEBT provides good palliation in patients with cutaneous T-cell lymphoma with a satisfactory response and toxicity profile . HTSEBT allows therapy to be completed in far fewer treatments . Low-dose HTSEBT is an appropriate treatment option for patients unable to come for daily treatment . HTSEBT provides a way to decrease exposure to other patients and staff during public health emergencies such as the coronavirus disease 2019 (COVID-19) pandemic.