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Dose-de-escalated focal radiotherapy for primary cutaneous T-cell lymphoma: a lesion-based retrospective cohort study
Philipp Linde1, Kathrin Wagner2, Johannes Rosenbrock2
1Department of Radiation Oncology, Cyberknife and Radiation Therapy, Faculty of Medicine and University Hospital of Cologne, University of Cologne, Cologne, Germany; Center for Integrated Oncology (CIO), University Hospital of Cologne, Faculty of Medicine and University of Cologne, Cologne, Germany. philipp.linde@uk-koeln.de.
Background And Purpose:
Radiotherapy (RT) is effective for cutaneous T-cell lymphoma (CTCL), but the optimal focal dose remains debated. We evaluated lesion response, local control, toxicity and patient satisfaction after 2 × 4 Gy compared with higher-dose regimens. Patient/material and methods: This single-centre retrospective study included CTCL patients treated with RT between 1990 and 2019 at a German university hospital. Lesions receiving 2 × 4 Gy (low-dose) were compared with lesions treated with higher doses (median 34 Gy). Endpoints were complete response (CR), overall response (OR), 1- and 5-year local control rate (LCR; Kaplan-Meier/log-rank), in-field relapse and toxicity (common terminology criteria for adverse events/ Radiation Therapy Oncology Group (RTOG)-European Organisation for Research and Treatment of Cancer). Patient satisfaction Freiburg Index of Patient Satisfaction (FIPS) was assessed in a subsample.
Results:
Thirty-two patients with 227 lesions were analysed (195 low-dose; 32 higher-dose). CR was achieved in 88.2% vs 90.6% and OR in 94.4% vs 100%, respectively (low- vs higher-dose). LCR was inferior after low-dose RT, with 1- and 5-year LCR estimates of 82 and 67% versus 100 and 96% after higher-dose RT (log-rank p = 0.013). In-field relapse occurred in 20.1% (37/184) vs 3.6% (1/28) of lesions with follow-up (Fisher p = 0.034). No toxicity > grade 2 was observed, and did not differ between groups (p = 0.695 and p = 0.657). In 11 FIPS questionnaires, satisfaction was high (mean score 1.27; median 1).
Interpretation:
Low-dose 2 × 4 Gy yields excellent initial response with minimal toxicity, but inferior local control compared with higher-dose focal RT. Findings support intent-based dosing: 2 × 4 Gy for symptom-driven treatment with re-irradiation as a pragmatic option, and higher-dose RT when durable local control is the primary objective.