What is the role of total skin electron (TSE) treatment in managing cutaneous T-cell lymphoma?

From the Guidelines

Total skin electron therapy (TSE) is a highly effective treatment for mycosis fungoides with extensive skin involvement, achieving complete response rates of 60-90% in early-stage disease and 40-60% in advanced disease, as reported in the most recent study 1.

Role of TSE in Managing Cutaneous T-Cell Lymphoma

The role of TSE in managing cutaneous T-cell lymphoma, particularly mycosis fungoides, is well-established. TSE delivers low-energy electrons to the entire skin surface, sparing internal organs, and is typically used for patients with extensive skin involvement.

• The standard regimen involves 30-36 Gy delivered over 8-10 weeks, though lower doses of 10-12 Gy may be used for palliative treatment or in combination therapy.
• TSE requires specialized radiation oncology facilities and expertise, with patients positioned in multiple standing positions to ensure uniform dose distribution.
• Common side effects include skin erythema, desquamation, hair loss, and nail changes, while long-term complications may include skin atrophy, telangiectasias, and secondary skin cancers.

Indications for TSE

TSE is particularly valuable for patients with:

• Widespread skin disease who have failed topical therapies and systemic treatments.
• Extensive cutaneous disease (stage T2b), where it can be considered as first-line treatment.
• Stage IB mycosis fungoides that has relapsed or is refractory to other skin-directed therapies, where TSE can be considered as second-line treatment.

Evidence Supporting TSE

The evidence supporting the use of TSE in cutaneous T-cell lymphoma is robust, with multiple studies demonstrating its efficacy in achieving complete responses and improving symptoms 1.

• A study published in the British Journal of Dermatology in 2019 reported overall response rates of 95-100% and complete response rates of 47-75% in patients with mycosis fungoides treated with TSE 1.
• The ESMO clinical practice guidelines for diagnosis, treatment, and follow-up of primary cutaneous lymphomas also recommend TSE as a treatment option for patients with extensive skin involvement 1.

From the Research

Role of Total Skin Electron Treatment in Managing Cutaneous T-Cell Lymphoma

• Total skin electron (TSE) treatment is a effective therapy for managing cutaneous T-cell lymphoma (CTCL) and Sézary syndrome with skin burden 2, 3, 4, 5.
• Low-dose TSE regimens (10-12 Gy) appear to be an effective alternative to conventional-dose TSE (30-36 Gy), yielding short-term remission of cutaneous manifestations with minimal toxicity 3, 4, 5.
• TSE treatment can be administered to patients at any time after a diagnosis of mycosis fungoides (MF) and can provide rapid relief from cutaneous lesions or symptoms 3.
• The overall response rate to TSE treatment is high, with complete response rates ranging from 50-63% and partial response rates ranging from 25-42% 2, 4, 5.
• TSE treatment is well tolerated, with low-grade adverse events and minimal toxicity, making it an appropriate treatment option for patients who are unable to undergo daily treatment or have limited access to healthcare facilities 2, 4, 5.

Comparison of Different TSE Regimens

• Studies have compared the efficacy of different TSE regimens, including low-dose and conventional-dose regimens, and found similar overall response rates and median time to progression 5.
• The choice of TSE regimen may depend on individual patient factors, such as disease stage, skin involvement, and overall health status 3, 4, 5.
• Further research is needed to determine the optimal TSE regimen for patients with CTCL and to identify prognostic factors that can help guide treatment decisions 3, 4, 5.

Combination Therapy

• TSE treatment can be used in combination with other therapies, such as systemic therapy, to enhance treatment outcomes and improve patient survival 6.
• The use of TSE treatment in combination with other therapies may help to reduce the risk of relapse and improve disease-free survival 3, 4, 5.
• Further research is needed to determine the optimal combination of therapies for patients with CTCL and to identify the most effective treatment strategies 6.