Radiation therapy in the management of cutaneous T-cell lymphomas

The lesions of mycosis fungoides (MF), a neoplasm of T lymphocytes, are extremely radiosensitive. The history of ionizing radiation in the treatment of MF is discussed in this paper. Low-energy X-rays have long been successful in the treatment of individual lesions and in the effective palliation of patients with this disease. The major breakthrough in the treatment of MF with ionizing radiation came with the development of the ability to treat the total skin by means of electrons which penetrate to depths of only 1--2 cm, thereby treating the epidermis and dermis while sparing more deeply situated tissues. The complications and results of this therapy are reviewed. The aggressive use of electron-beam therapy has resulted in many long-term remissions. It is important to use high initial doses of radiation and to treat patients when they are still in the early stages of disease. The potential use of other modalities of radiation, including total-lymphoid radiation with megavoltage photons, low-dose fractionated total-body radiation, and sequential hemibody radiation, are reviewed.