Twelve consecutive patients with advanced stage
mycosis fungoides (MF) were treated with combined total body X ray irradiation (TBI) and total skin electron beam
radiotherapy (EBRT). Six had generalized plaque disease and dermatopathic nodes, three had
tumor stage disease and node biopsy positive for
mycosis fungoides, and three had
erythroderma/Sezary syndrome. The treatment regimen consisted of split course total body X ray irradiation, given in twice weekly 15 cGy fractions to 75 cGy, then total skin electron beam
radiation therapy given in once weekly 400 cGy fractions to a total dose of 2400 cGy. Underdosed areas and areas of greatest initial involvement were boosted 400 cGy twice weekly for an additional 1200 cGy. This was followed by a second course of total body X ray irradiation, to a total dose of 150 cGy. The total skin electron beam
radiotherapy technique is a modification of an established six position EBRT technique for
mycosis fungoides. Measurements to characterize the beam with and without a
lexan scattering plate, demonstrated that the combination of no-plate beams produced better dose uniformity with a much higher dose rate. This improved technique is particularly advantageous for elderly and/or frail patients. Nine (75%) of the 12 patients achieved complete response (CR). The other three had significant improvement with greater than 80% clearing of their disease and resolution of symptoms. All six patients with generalized plaque disease achieved complete response and remained free of disease from 2 to 16 months. Two of three node positive patients also achieved complete response; one, with massive biopsy-documented
mycosis fungoides nodal disease and deep open
tumors, remained relapse-free over 2 years. Only one of the three patients with
erythroderma/Sezary syndrome achieved a complete response, which was short lived.
Therapy was well tolerated. No significant hematological toxicity occurred. Although total body X ray irradiation and total skin electron beam
radiotherapy produced excellent palliation of patients with advanced stage
mycosis fungoides, new strategies to provide more effective systemic treatment are needed.