Low-dose total skin electron beam therapy: Quality of life improvement and clinical impact of maintenance and adjuvant treatment in patients with mycosis fungoides or Sezary syndrome

Elsayad, Khaled; Kroeger, Kai; Greve, Burkhard; Moustakis, Christos; Assaf, Chalid; Stadler, Rudolf; Lenz, Georg; Weishaupt, Carsten; Eich, Hans Theodor

doi:10.1007/s00066-019-01517-7

Cited by 18 publications

(18 citation statements)

References 35 publications

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“…Recent studies indicate that maintenance therapy after TSEBT may improve the PFS (Elsayad et al 2020b;Heumann et al 2015;Jennings et al 2019). Low-dose focal radiotherapy combined with romidepsin therapy seems to be safe and reasonable option in patients with symptomatic lesions (Akilov et al 2012).…”

Section: Discussionmentioning

confidence: 99%

“…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 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).…”

Section: Introductionmentioning

confidence: 99%

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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

Rolf

Elsayad

Eich

2020

J Cancer Res Clin Oncol

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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.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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

Rolf

Elsayad

Eich

2020

J Cancer Res Clin Oncol

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“…The most frequent and salient patient concerns identified from the current interviews were then examined for their presence in a selection of QoL instruments, including the SF‐36, HUI3, DLQI, Skindex‐29 and MF/SS‐CTCL QoL 15,17,19,29,30 . The SF‐36 is the most widely used QoL measure in research to date; the HUI3 provides additional insight into the economic impact of varying degrees of QoL impairment; the DLQI is the most widely used QoL instrument in dermatology; and the Skindex‐29 is often used to assess QoL among patients with cutaneous lymphoma, as it incorporates additional psychological aspects of QoL not addressed in the DLQI 16,18,25,31–33 . The final developed codebook was applied to these existing QoL instruments, with coding performed by T.S.B.…”

Section: Methodsmentioning

confidence: 99%

“…15,17,19,29,30 The SF-36 is the most widely used QoL measure in research to date; the HUI3 provides additional insight into the economic impact of varying degrees of QoL impairment; the DLQI is the most widely used QoL instrument in dermatology; and the Skindex-29 is often used to assess QoL among patients with cutaneous lymphoma, as it incorporates additional psychological aspects of QoL not addressed in the DLQI. 16,18,25,[31][32][33] The final developed codebook was applied to these existing QoL instruments, with coding performed by T.S.B. and code assignment confirmed by A.C.M.…”

Section: Comparison With Existing Quality-of-life Instrumentsmentioning

confidence: 99%

Current measures are not sufficient: an interview‐based qualitative assessment of quality of life in cutaneous T‐cell lymphoma*

et al. 2020

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Summary Background Cutaneous T‐cell lymphoma (CTCL) negatively impacts quality of life (QoL), but existing QoL questionnaires may not comprehensively reflect patients’ experience. Objectives To identify the aspects of QoL that are most meaningful to patients with CTCL and to evaluate existing QoL instruments in this context. Methods Semistructured interviews were conducted between May and June 2019 using purposive sampling of patients with CTCL. Data were analysed by an inductive thematic approach using Dedoose Version 8.0.35. Results One‐on‐one interviews lasting a median of 43 min were completed by 18 patients [median age 62 years (interquartile range 52–70); 39% advanced‐stage (IIB–IV)]. Itch was the most common clinical symptom reported (16 of 18 patients), followed by pain (12 of 18), skin breaks (11 of 18) and skin flaking (10 of 18). Eleven patients reported that their symptoms interfered with sleep, which impacted daily functioning. Patients also noted a lack of understanding of the disease in the community and felt uncertain (12 of 18), depressed (11 of 18), suicidal (four of 18) and hopeless (nine of 18). Nearly all patients (17 of 18) reported a sense of ‘otherness’ (not feeling ‘normal’ or ‘like themselves’), and most patients (16 of 18) specifically mentioned concern about their physical appearance. Patients also noted substantial treatment burden. Salient patient concerns, including individual clinical symptoms, concern about appearance and problems with sleep, were not adequately or consistently represented in generic, skin‐specific or CTCL‐specific QoL measures. Conclusions Incorporating the concerns and priorities that distinguish patients with CTCL from other patient populations will be of paramount importance in developing a comprehensive CTCL‐specific measure of QoL that adequately captures patients’ experience.

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“…Kroeger et al achieved adequate treatment results with fewer grade 2 skin toxicities with low-dose (12 Gy) TSEI compared to conventional doses [16]. Additionally, the low total dose is important in terms of the need for a second treatment and improved quality of life [17,18]. Today, for TSEI, a total dose of 12-36 Gy is often preferred as 4-6 Gy per week, and complete response rates are 90% and above some series [19][20][21].…”

Section: Discussionmentioning

confidence: 99%

Ultra-Low-Dose Radiotherapy for Palliation of Mycosis Fungoides

Aral¹,

Gürok

Konuk

et al. 2020

Case Reports in Dermatological Medicine

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Introduction. Mycosis fungoides (MF) is a form of primary cutaneous T-cell lymphomas, and radiotherapy (RT) has been used to treat localized/limited lesions of MF. In this case report, the results of low-dose RT applied for palliative purpose are shared. Case Report. A 70-year-old male patient was admitted to the outpatient clinic 7 months ago with a generalized itchy rash. The result of the biopsy was reported as mycosis fungoides. Systemic treatment was not performed due to comorbid diseases. The hemibody RT was applied. 2 Gy was given per fraction, with a total dose of 6 Gy. The significant clinical relief was observed with 6 Gy RT. The patient died due to multiorgan failure 2 months later, and no recurrence was observed. Conclusion. The palliation was achieved in the advanced MF patient with fractionated 6 Gy hemibody RT for the remaining 2 months of life.

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Low-dose total skin electron beam therapy: Quality of life improvement and clinical impact of maintenance and adjuvant treatment in patients with mycosis fungoides or Sezary syndrome

Cited by 18 publications

References 35 publications

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

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

Current measures are not sufficient: an interview‐based qualitative assessment of quality of life in cutaneous T‐cell lymphoma*

Ultra-Low-Dose Radiotherapy for Palliation of Mycosis Fungoides

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