Total Skin Electron Therapy for Cutaneous T Cell Lymphoma Using Modern Dual Field Rotational Technique: An Institutional Analysis of Overall Clinical Outcomes and the Effect of Race on Treatment Response Open Access

Heumann, Thatcher Ross (2016)

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Purpose/Objective(s): To report our experience with rotational total skin electron

irradiation (RTSEI) in cutaneous t-cell lymphoma (CTCL), and to examine response by

disease stage and race.

Materials/Methods: We reviewed our outcomes of 68 CTCL patients who received

RTSEI (30+ Gy) from 2000- 2013. Primary outcomes were complete clinical response

(CCR), recurrence-free survival (RFS), and overall survival (OS). Using log-ranks tests and

Cox proportional hazards, OS and RFS were compared across tumor stages at time of

RTSEI with further racial subgroup analysis.

Results: Median age at diagnosis and at time of radiation were 52 and 56 years,

respectively. Median follow up was 5.1 years, 49% were African American (AA), and 49%

were female. At time of treatment, 18, 37, and 13 patients were T-stage 2, 3, and 4,

respectively. At 6 weeks post RTSEI, overall CCR was 82% (88%, 83%, 69% for T2, T3, and

T4, respectively). Median RFS was 11 months for all patients and 14, 10 and 12 months

for stage T2, T3, and T4, respectively. T-stage was not associated with RFS or CCR.

Maintenance therapy following RTSEI was associated with improved RFS and OS in both

crude and multivariable analysis, controlling for T-stage. Median OS was 76 months and

91 and 59 months for T3 and T4, respectively). With the exception of improved OS with

AAs compared to Whites at stage T2, race was not associated with CCR, RFS, or OS.

Conclusions: These results represent the largest RTSEI clinical outcomes study in the

modern era using dual field rotational technique. Our observed response rates match or

improve upon the standard set by previous outcome studies using conventional TSEI

techniques, despite a large percentage of advanced CTCL lesions in our cohort. We

found that clinical response following RTSEI did not appear to be affected by T-stage nor


Table of Contents

Chapter 1: Background/Literature Review 1

Background on Cutaneous T-Cell Lymphoma 1

Overview of Total Skin Electron Irradiation 2

Race and Cutaneous T-Cell Lymphoma 4

Race and Radiotherapy 5

Chapter II: Manuscript 6

Title Page 6

Abstract 7

Introduction 9

Methods 10

Results 13

Discussion 17

References 24

Tables and Figures 29

Table 1: Study Population Characteristics 30

Table 2: Descriptive Statistics and Comparisons by Race 31

Table 3: Complete Clinical Response Rates by T-Stage 32

Table 4: Summary of Recurrence-Free Survival by T-Stage & Race 34

Table 5: Predictors of Recurrence-Free Survival 35

Table 6: Summary of Overall Survival by T-Stage and Race 37

Table 7: Predictors of Overall Survival 38

Table 8: Summary of TSEI Clinical Outcome Studies 40

Figure 1: Recurrence Free Survival Curves by T-Stage and Race 41

Figure 2: Overall Survival Curves by T-Stage and Race 42

Chapter III: Summary, Public Health Implications, and Future Directions 43

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