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Title: Lack of durable remission with conventional-dose total skin electron therapy for the management of Sezary syndrome and multiple relapsed mycosis fungoides.
Epworth Authors: Prince, Miles
Other Authors: Campbell, Belinda
Ryan, Gail
McCormack, Christopher
Tangas, Eleanor
Bressel, Mathias
Twigger, Robert
Buelens, Odette
van der Weyden, Carrie
Keywords: Durable Remission
Total Skin Electron Therapy (TSE)
Sezary Syndrome
Multiply Relapsed Mycosis Fungoides (MF)
Cutaneous T-cell Lymphomas
Conventional-dose TSE (cdTSE)
Symptom Control
Tolerability Against Response Durability
Overall Survival (OS)
Inferior Prognosis
Skin-Directed Therapy
Time to Next Treatment (TTNT)
Systemic Treatments
Haematopoietic Stem Cell Transplantation (HSCT)
High-Grade Transformation
Autologous Stem Cell Transplant (SCT)
Allogeneic Haematopoietic SCT (HSCT)
Rotary-Dual Technique
Surrogate endpoint
Epworth Centre for Immunotherapies and Snowdome Laboratories
Molecular Oncology and Cancer Immunology
Cancer Services Clinical Institute, Epworth HealthCare, Victoria, Australia
Issue Date: Nov-2019
Publisher: Multidisciplinary Digital Publishing Institute (MDPI)
Citation: Cancers, 11(11), 1758.
Abstract: Mycosis fungoides (MF) and Sezary syndrome (SS) are multi-relapsing, morbid, cutaneous T-cell lymphomas. Optimal treatment sequencing remains undefined. Total skin electron therapy (TSE) is a highly technical, skin-directed treatment, uniquely producing symptom-free and treatment-free intervals. Recent publications favour low-dose TSE for reduced toxicity, but early data support conventional-dose TSE (cdTSE) for longer disease control. Patient selection requires weighing-up tolerability against response durability. We investigated duration of benefit from cdTSE in patients with poorer prognosis diseases: SS and heavily pre-treated MF. Endpoints were overall survival, and “time to next treatment” (TTNT) as surrogate for clinical benefit duration. Seventy patients (53 MF, 17 SS) were eligible: median prior treatments, 4; median cdTSE dose, 30 Gy; median follow-up, 5.8 years. SS patients had worse prognosis (HR = 5.0, p < 0.001) and shorter TTNT (HR = 4.5, p < 0.001) than MF patients; median TTNT was only 3.7 months. Heavily pre-treated MF patients had inferior prognosis (HR = 1.19 per additional line, p = 0.005), and shorter TTNT (HR = 1.13 per additional line, p = 0.031). Median TTNT for MF patients with ≥3 prior treatments was 7.1 months, versus 23.2 months for 0–2 prior treatments. In conclusion, cdTSE has a limited role in SS. TTNT is reduced in heavily pre-treated MF patients, suggesting greater benefit when utilized earlier in treatment sequencing.
DOI: 10.3390/cancers11111758
PubMed URL:
ISSN: 2072-6694
Journal Title: Cancers (Basel)
Type: Journal Article
Affiliated Organisations: Department of Radiation Oncology, Peter MacCallum Cancer Centre, Melbourne 3000, Victoria, Australia
Department of Clinical Pathology, The University of Melbourne, Parkville 3010, Victoria, Australia
Department of Surgical Oncology, Peter MacCallum Cancer Centre, Melbourne 3000, Victoria, Australia
Department of Dermatology, St Vincent’s Hospital Melbourne, Fitzroy 3065, Victoria, Australia
Melbourne Clinical School, School of Medicine, University of Notre Dame, Werribee 3030, Victoria, Australia
Centre for Biostatics and Clinical Trials, Peter MacCallum Cancer Centre, Melbourne 3000, Victor
Department of Clinical Haematology, Peter MacCallum Cancer Centre and Royal Melbourne Hospital, Melbourne 3000, Victoria, Australia
Sir Peter MacCallum Department of Oncology, The University of Melbourne, Parkville 3010, Victoria, Australia
Type of Clinical Study or Trial: Clinical Trial
Appears in Collections:Cancer Services

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