LOCAL SUPERFICIAL RADIOTHERAPY IN THE MANAGEMENT OF MINIMAL STAGE IA CUTANEOUS T-CELL LYMPHOMA (MYCOSIS-FUNGOIDES)

Purpose: To evaluate the impact of local superficial radiotherapy with respect to local control, survival, and toxicity for patients with '' minimal'' stage IA cutaneous T-cell lymphoma (Mycosis Fungoides). Meth ods and Materials: Between 1954 and 1996 a total of 21 patients were i dentified as receiving curative local superficial radiation (LSR) for minimal stage IA Mycosis Fungoides. All patients had pathologic docume ntation at diagnosis and at the time of suspected recurrences and no p atient received prior radiation. Ten patients were treated with 100-28 0 Kv (Al), and 11 with 4-12 Mev electrons. Nine patients had failed pr ior therapies (steroids: 4; PUVA: 3; BCNU: 1; UVB: 1) and six received adjuvant therapy after completion of LSR (PUVA: 5; steroids: 1). Mini mum follow-up was 1 year. Results: The median follow-up was 36 months (13-246), and the median age when commencing LSR was 55 years (27-73). All patients were Caucasian, and II were male. A total of 32 lesions were identified in 21 patients; 13 patients had unilesional disease, 5 patients had 2 lesions, and 3 had 3 lesions. A total of 33 fields wer e treated with a median treatment surface area of 107 cm(2) (11-785). The median surface dose was 20 Gy (6-40), with 17 patients receiving a dose greater than or equal to 20 Gy. The median fraction number was 5 for all fields, but was 10 for the fields receiving 20-40 Gy. The com plete response rate was 97%, and all patients were alive at fast evalu ation. All failures were cutaneous. One patient had persistent disease (treated with 6 Gy), and three failed locally at 52 months (8 Gy), 16 months (20 Gy), and 4 months (20 Gy). None of these patients received adjuvant therapy. Two patients failed in distant skin sites and were salvaged. The actuarial DFS for the entire group at 5 and 10 years was 75 and 64%, respectively, with local control of 75% at both time inte rvals. For the 13 patients with unilesional disease, the DFS was 85% a t 10 years. For those treated with doses greater than or equal to 20 G y, the DFS was 91% as was local control (no distant failures). Toxicit y included mild erythema and dry desquamation acutely. Chronic toxicit y included dermatitis [2], and telangiectasia [1]. No second cutaneous malignancies or hematologic toxicity was noted, Conclusion: Patients with minimal Stage IA Mycosis Fungoides may be managed effectively wit h local superficial radiation alone without adjuvant therapy. Distant failure is unusual and patients should receive a minimum surface dose of 20 Gy, which offers excellent local control. Sequalae of therapy ar e minimal. (C) 1998 Elsevier Science Inc.