IMPACT OF NON-CTCL DERMATOLOGICAL DIAGNOSES AND ADJUVANT THERAPIES ONCUTANEOUS T-CELL LYMPHOMA PATIENTS TREATED WITH TOTAL SKIN ELECTRON-BEAM RADIATION-THERAPY

Purpose: To evaluate the impact of pre-cutaneous T-cell lymphoma derma tologic diagnoses and adjuvant therapies on the relapse-free and overa ll survivals of patients treated with total skin electron beam therapy . Methods and Materials: Between 1974 and 1990, 164 patients were eval uated by members of Yale University School of Medicine departments of Dermatology and Therapeutic Radiology and treated with total skin elec tron beam therapy to a total dose of 3600 cGy. Patients who achieved a clinical complete response were offered doxorubicin/cyclophosphamide chemotherapy, extracorporeal photopheresis, or no systemic adjuvant th erapy. The effects of TNM stage, antecedent non-T-cell lymphoma dermat ologic diagnoses, and systemic adjuvant therapies were analyzed for th eir impact on relapse-free and overall survival. Results: In this coho rt of patients, an antecedent dermatologic diagnosis of follicular muc inosis or lymphomatoid papulosis was significantly associated with a s horter relapse-free survival for T1 and T2 patients, while antecedent ''non-specific'' dermatitides were associated with a somewhat better r elapse-free survival. When the impact of systemic adjuvant therapies w as analyzed, neither systemic doxorubicin/cyclophosphamide chemotherap y nor systemic extracorporeal photopheresis were found to delay cutane ous relapse. Conclusion: Our results suggest that antecedent follicula r mucinosis and lymphomatoid papulosis may be associated with short re lapse-free survival in T1 and T2 patients treated with total skin elec tron beam therapy. They also imply that neither adjuvant chemotherapy nor extracorporeal photopheresis delay cutaneous relapse after total s kin electron beam therapy.