Background
Retrospective review of the Stanford University experience with conventional-dose TSEBT (≥30 Gy) for mycosis fungoides (MF). 180 patients with T2 (generalized patch/plaque, n=103) or T3 (tumor stage, n=77) MF treated 1970–2007. Assessed ORR, CR rate, OS, PFS, and the value of adjuvant topical nitrogen mustard (HN2) after TSEBT.
Interventions and follow up
Arm A: TSEBT ≥30 Gy + adjuvant topical nitrogen mustard (HN2) after completio
Arm B: TSEBT ≥30 Gy alone (monotherapy); retrospective compariso
Primary endpoint: Overall response rate, CR rate, freedom from relapse (FFR), OS, PFS
mFollow up: Not specified (1970–2007 accrual)
Arm B: TSEBT ≥30 Gy alone (monotherapy); retrospective compariso
Primary endpoint: Overall response rate, CR rate, freedom from relapse (FFR), OS, PFS
mFollow up: Not specified (1970–2007 accrual)
Results
ORR: 100% (all patients responded)
CR rate (overall): 60%; T2 MF 75%, T3 MF 47%
5-Year OS: 59%; 10-year OS 40%
Adjuvant HN2 vs. TSEBT alone: No significant difference in FFR (T2 P=.30; T3 P=.50), PFS, or OS
Repeat TSEBT: ORR 100% at second course; median FFR 6 months
CR rate (overall): 60%; T2 MF 75%, T3 MF 47%
5-Year OS: 59%; 10-year OS 40%
Adjuvant HN2 vs. TSEBT alone: No significant difference in FFR (T2 P=.30; T3 P=.50), PFS, or OS
Repeat TSEBT: ORR 100% at second course; median FFR 6 months
Adverse events
Main adverse events: TSEBT (≥30 Gy): alopecia (universal), nail dystrophy, skin dryness/desquamation, leg edema, hypohidrosis (long-term), cataracts (if eye shields not used). Adjuvant HN2: contact dermatitis. Second-course TSEBT generally safe.
Conclusions
TSEBT ≥30 Gy achieves universal response (100% ORR) with 60% CR in T2/T3 MF. T2 disease responds significantly better than T3 (CR 75% vs 47%). Adjuvant HN2 after TSEBT provides no benefit. Repeat courses of TSEBT are feasible and provide meaningful palliation.
Key Limitations
Key Limitations: Retrospective; 37-year accrual period with evolution in RT technique, staging, and skin care supportive management; no central pathology review; T2/T3 staging heterogeneous; modern therapies (brentuximab, mogamulizumab) not available for comparison or combination.
Clinical Context
The Stanford TSEBT program is the world's largest published experience and establishes the benchmark for conventional-dose TSEBT outcomes. 30 Gy TSEBT remains standard for thick plaques or tumor-stage MF. The finding of no benefit from adjuvant HN2 simplified post-TSEBT management. Repeat TSEBT feasibility supports re-treatment strategies in relapsed disease.
References