Acute and sub-acute toxicity profile of ultra-hypofractionated low-dose total skin electron beam with two 4 Gy fractions
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ORIGINAL ARTICLE – CLINICAL ONCOLOGY
Acute and sub‑acute toxicity profile of ultra‑hypofractionated low‑dose total skin electron beam with two 4 Gy fractions for cutaneous T cell lymphoma Daniel Rolf1 · Khaled Elsayad1 · Hans Theodor Eich1 Received: 17 September 2020 / Accepted: 31 October 2020 © The Author(s) 2020
Abstract Purpose Low-dose total skin electron beam therapy (TSEBT) over 3 weeks has proved to be a safe and effective treatment for cutaneous T cell lymphomas (CTCL). In this prospective trial, we examined the feasibility of ultra-hypofractionated low-dose TSEBT regimen in two fractions with 4 Gy combined with systemic therapy to minimize the number of visits to radiation centers. Patients and methods Six patients with mycosis fungoides (MF) or Sézary syndrome (SS) received TSEBT with a total radiation dose of 8 Gy in two fractions between April 2020 and June 2020. Patient and treatment characteristics, tumor burden, the impact on the quality of life using Skindex-29 questionnaires, and acute toxicities were analyzed. Results During TSEBT, all patients developed grade 1 toxicities while two patients developed grade 2 toxicities. One patient experienced sepsis. The most common adverse effects were erythema and edema. All grade 2 toxicities regressed after 4 weeks following TSEBT. Based on the reported symptoms measured by Skindex-29, we detected a significant reduction in total Skindex-29 score after 8 weeks of radiation (P = 0.03), particularly in the symptoms (P = 0.01) and emotional domains (P = 0.04). Conclusion Ultra-hypofractionated low-dose TSEBT followed by systemic therapy seems to be a safe and feasible alternative to conventional fractionated TSEBT for patients with MF/SS. The skin tumor burden and the health-related quality of life have been significantly improved within 8 weeks following radiotherapy. Keywords Radiotherapy · Two fractions · Erythema · Bexarotene · Mogamulizumab · Acitretin · Extracorporeal photopheresis (ECP)
Introduction Nowadays, there is a global need to reduce cancer patients and radiation oncology staff’s exposure to the potential risk of COVID-19 infection, or due to limited resources (Chen et al. 2020). Low-dose total skin electron beam therapy (TSEBT) in the range of 10–12 Gy over 3 weeks is a current treatment option for cutaneous T cell lymphoma (CTCL) with excellent response rate and minimal risk of adverse Daniel Rolf and Khaled Elsayad contributed equally to this work. * Khaled Elsayad Khaled.elsayad@uni‑muenster.de 1
events (Elsayad et al. 2017; Kroeger et al. 2017; Mehta-Shah et al. 2020). Prior studies show that low-dose TSEBT could improve disease symptoms, tumor burden, and patients’ health-related quality of life (HRQL) in CTCL (Elsayad et al. 2020b; Hoppe et al. 2015). TSEBT can be combined with systemic therapy to improve PFS (Elsayad et al. 2020a). During the COVID-19 Pandemic, the International Lymphoma Radiation Oncology Group (ILROG) suggests hypofractionated TSEBT as a valid option for patients with CTCL to reduce the overall treatment
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