Total skin electron beam therapy for cutaneous lymphomas and leukemias

Total skin electron beam therapy (TSEB) was used in the treatment of 33 patients with lymphoma and 13 patients with leukemia involving extensive segments of the skin surface. Twenty-two of 23 had skin lesions as a primary manifestation of lymphoma (primary cutaneous lymphoma--PCL) and 11 developed cutaneous lesions following disseminated nodal lymphoma (secondary cutaneous lymphoma--SCL). A once weekly fractionation scheme was employed to irradiate the entire skin surface with 3.5 to 4 MeV electron beam from a 6 MeV linear accelerator. During each weekly session, 400 rad were delivered to the entire skin and a complete course consisted of 4-6 consecutive weekly sessions. The majority of patients have been previously treated elsewhere for various periods and all patients have been at risk for a median of 12 months, range from 12-117 months following TSEB. Striking predominance of the diffuse pattern (76%) was demonstrated in both the PCL and SCL. There was extracutaneous involvement in 63% (13/22) of the PCL, nodal or visceral at onset of TSEB; median follow-up was 24 months, range 6-117 months; 20/22 (90%) of all patients obtained prompt relief of symptoms and complete regression of cutaneous lesions. Duration of cutaneous remission ranged from 6-96 months, median 18 months; in general, duration was adversely influenced by the presence of visceral involvement at onset of TSEB. Although cutaneous response among the patients with SCL and leukemia was equally good, many of these patients were treated for palliation because of rapid progression of their disease. Once weekly treatments were highly effective, well-tolerated and no untoward immediate or late effects have been noted in the bone marrow or normal skin irradiated.