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    TSEBT

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    cornejo1
    Total skin electron beam therapy (TSEBT) is an effective treatment for mycosis fungoides (MF), the most common type of cutaneous T-cell lymphoma. TSEBT typically involves delivering 30-36 Gy over 8-10 weeks in 2 Gy fractions to the entire skin surface using electron energies of 4-9 MeV. Multiple studies have shown TSEBT achieves high complete response rates for MF, ranging from 36-96% depending on disease stage. Higher skin doses above 32 Gy and energies of 4-6 MeV are associated with better response rates.

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    TSEBT

    Uploaded by

    cornejo1
    124 views17 pages
    Total skin electron beam therapy (TSEBT) is an effective treatment for mycosis fungoides (MF), the most common type of cutaneous T-cell lymphoma. TSEBT typically involves delivering 30-36 Gy over 8-10 weeks in 2 Gy fractions to the entire skin surface using electron energies of 4-9 MeV. Multiple studies have shown TSEBT achieves high complete response rates for MF, ranging from 36-96% depending on disease stage. Higher skin doses above 32 Gy and energies of 4-6 MeV are associated with better response rates.

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    Total skin electron beam therapy

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    Total skin electron beam therapy (TSEBT) is an effective treatment for mycosis fungoides (MF), the most common type of cutaneous T-cell lymphoma. TSEBT typically involves delivering 30-36 Gy over 8-10 weeks in 2 Gy fractions to the entire skin surface using electron energies of 4-9 MeV. Multiple studies have shown TSEBT achieves high complete response rates for MF, ranging from 36-96% depending on disease stage. Higher skin doses above 32 Gy and energies of 4-6 MeV are associated with better response rates.

    Copyright:

    Attribution Non-Commercial (BY-NC)
    Download as PPTX, PDF, TXT or read online from Scribd
    Download as pptx, pdf, or txt
    124 views17 pages

    TSEBT

    Uploaded by

    cornejo1
    Total skin electron beam therapy (TSEBT) is an effective treatment for mycosis fungoides (MF), the most common type of cutaneous T-cell lymphoma. TSEBT typically involves delivering 30-36 Gy over 8-10 weeks in 2 Gy fractions to the entire skin surface using electron energies of 4-9 MeV. Multiple studies have shown TSEBT achieves high complete response rates for MF, ranging from 36-96% depending on disease stage. Higher skin doses above 32 Gy and energies of 4-6 MeV are associated with better response rates.

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    Total Electric Skin Beam Therapy in Mycosis Fungoides

    Chrissy Cornejo

    Outline
    Background on mycosis fungoides What is total skin electron beam therapy? Treatment of MF with TSEB Evidence for low dose TSEB

    Total skin electron beam therapy


    Fields: stationary (multiple dual angle) or rotational Energy: 4-9 MeV
    Less than 5% of dose penetrates beyond 2 cm

    6 Positions: AP, PA, RAO, LAO, RPO, LPO Stanford protocol

    Smith et al, 2007.

    2 Gy per cycle to a total dose to 30-36 Gy over 8-10 weeks -> 1 week gap in tx for relief from skin RT rxn Cycle: Day 1-AP, RPO, LPO; Day 2- PA, RAO, LAO

    TSEB set-up

    Morris. 2012.

    Smith et al. Oncology, 2003

    EORTC Recommendations for TSEB


    80% isodose should be at least 4 mm deep to skin surface Dose at 20 mm deep should be less than 20% maximum dose at skin surface Photon contamination at level of bone marrow must be less than 0.7 Gy for a full course of TSEB to avoid hematological sequelae

    TSEBT Toxicities

    Who do we treat?
    Primary application = MF
    1st line for extensive patch/plaque disease that is too extensive for topical tx 2nd line for stage IA/IB who have relapsed or progressed after sequential topical txs

    Other applications:
    Cancers arising in skin - Kaposis sarcoma Cancers metastasizing to skin - nodular or inflammatory breast cancer Skin dominated leukemia Anaplastic and B cell lymphomas Benign disorders of skin - scleroderma, lymphomatoid papulosis

    Classification of cutaneous lymphoma


    T-cell and NK-cell lymphomas
    Mycosis fungoides Mycosis fungoides variants and subtypes Folliculotropic MF Pagetoid reticulosis Granulomatous slack skin Sezary syndrome Adult T-cell leukemia/lymphoma Primary cutaneous CD30+ lymphoproliferative disorders Primary cutaneous anaplastic large cell lymphoma Lymphatoid papulosis Subcutaneous panniculitis-like T-cell lymphoma

    B-cell lymphomas
    Primary cutaneous marginal zone B-cell lymphoma Primary cutaneous follicle center lymphoma Primary cutaneous diffuse large B-cell lymphoma

    Mycosis fungoides is the most common subgroup of CTCL and has a heterogenous presentation

    A) Patch, B) Plaque, C) Large tumor with necrosis and ulceration, D) Generalized erythroderma

    Smith et al, 2007

    History of radiation for mycosis fungoides


    Dramatic responses of MF to low doses of X-ray therapy first reported by Sholtz in 1902 Early approach to management of MF using RT was entirely palliative individual lesion were treated with low doses of soft x-rays
    High rate of lesion recurrence Increased risk of side effects from penetrating RT

    Localized superficial radiotherapy has become an invaluable form of tx for all stages of MF

    Wheres the evidence?


    Study Design Methods Treatment
    TSEB only

    Results
    CR rates: 96% in stages IA/IB/IIA, 36% in stage IIB, 60% in stage III Greater skin dose (32-36 Gy) and higher energy (4-6 MeV) associated with higher rate of CR 5-year relapse free survivals of 1023%

    Jones et Meta952 patients al, 1995 analysis of with all stages open of CTCL uncontrolled and mostly retrospective studies Small RCT 42 patients treated with TSEB vs. topical mechlorethami ne

    Retrospectiv e study

    Study Design: Results:

    Current and future research


    Stanford, Phase I/II Study: Low dose (12 Gy) TSEBT + Vorinostat vs low dose TSEBT monotherapy in MF

    Take home points


    TSEB is an effective treatment for all stages of MF Standard TSEB regimen: 30-36 Gy delivered in 2 Gy fractions Low dose:

    Big thanks to
    Dr. Plastaras Abby Berman Jacob Shabason Everyone else!

    References
    Smith BD, Wilson LD: Cutaneous Lymphomas. Semin Radiat Oncol 17:158168, 2007 Chinn DM, Chow S, Kim YH, Hoppe RT. Total skin electron beam therapy with or without adjuvant topical nitrogen mustard or nitrogen mustard alone as initial treatment of T2 and T3 mycosis fungoides. Int J Radiat Oncol Biol Phys. 1999;43:951--8.53. Jones GW, Kacinski BM, Wilson LD, Willemze R, Spittle M, Hohenberg H, et al. Total skin electron radiation in the man- agement of mycosis fungoides: consensus of the European Organization for Research and Treatment of Cancer (EORTC) Cutaneous Lymphoma Project Group. J Am Acad Dermatol. 2002;47:36470 Jones GW, Hoppe RT, Glatstein E. Electron beam treatment for cutaneous T cell lymphoma. Haematol Oncol Clin North Am 1995;9:1057e1076. Harrison C, Young J, Navi D, et al. Revisiting low dose total skin electron beam radiotherapy in mycosis fungoides. Int J Radiat Oncol Biol Phys 2011;81(4):e651ee657. Kamstrup M, Specht L, Skovgaard G, et al. A prospective, open-label study of low-dose total skin electron beam therapy in mycosis fungoides. Int J Radiat Oncol Biol Phys 2008;71(4):1204e1207.

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