Introduction Primary cutaneous T-cell lymphomas are a heterogeneous group of T-cell neoplastic entities associated with significant morbidity and high radio-sensitivity. Although research of reduced-dose radiation treatment for mycosis fungoides (MF) and Sézary syndrome (SS) has significantly increased over the past two decades, randomized data is lacking.Objectives To summarize the available evidence and analyze the safety and efficacy of reduced-dose total skin electron beam therapy (TSEBT).Methods A literature search for evidence was conducted, selecting studies with reduced-dose TSEBT in MF and SS that met the inclusion criteria. The studies were critically appraised, and the results were synthesized and interpreted.Results The analyzed data comprised 11 prospective studies and 11 retrospective studies, with a total of 883 patients. The meta-analysis revealed a pooled overall response rate (ORR) of 91% (95%-confidence interval (CI): 88% to 93%) and complete response rate (CRR) of 26% (95%-CI: 21% - 31%) to reduced-dose TSEBT. The most common toxicities reported were grade 1 and 2 skin reactions. Documented in seven studies, the time to response ranged from 4-8 weeks. Seven studies evaluated the impact of reduced-dose TSEBT on quality of life (QoL), and all reported significant improvements in one or more subdomains. Fourteen studies indicated that 337 patients (38%) received consolidation therapy after TSEBT to maintain remission. When compared to TSEBT monotherapy, the addition of consolidation/subsequent treatments to sustain the response was associated with a progression-free survival (PFS) advantage in 4 out of 5 trials.Conclusion Reduced-dose TSEBT quickly achieves high ORR and improves QoL with minimal risk of severe adverse events. Knowledge gaps remain on how to optimally prolong these benefits. Investigating maintenance therapy is needed to ensure sustained remission.
Abai et al. (Tue,) studied this question.