Tratamiento de la micosis fungoide con terapia de haz de electrones de la piel total: experiencia real en un centro de excelencia para linfomas cutáneos en Bogotá, Colombia.

Abstract

Abstract:

Introduction: Total Skin Electron Beam Therapy (TSEBT) has established itself as an effective option for the management of cutaneous lymphomas such as mycosis fungoides. This technique allows for uniform treatment of the entire skin surface, making it a key alternative for patients with extensive disease resistant to conventional treatments.

Methods: A case series was conducted with 11 patients diagnosed with cutaneous lymphoma treated with TSEBT at a referral center. Demographic, clinical, and therapeutic variables, including clinical response, were analyzed with different tools such a Modified Severity-Weighted Assessment Tool (mSWAT) and the Pruritus Visual Analogue Scale (PVAS), toxicities, and early relapses. The information was obtained from clinical records between January 2023 and January 2025.

Results: In this series of 11 cases treated with Total Skin Electron Beam Therapy (TSEBT), 63.63% of patients (7) achieved complete response (CR), 27,27% (3) partial response (PR) with improvement between 50 and 99% of the clinical picture, thus achieving an ORR of 90.9%, and 9.1% (1) disease progression. Relapses were documented in 63.6% of cases with a mean follow-up of 8 months. Of the cases with CR, 66.7% relapsed. The index of the mSWAT decreased on average of 67.5% in patients who were taken to this treatment, initially averaging an mSWAT of 69.3 and a final average of 22.5;and the PVAS score improved going from an average of an initial average of 8.1/10 to a final score of 2.7/10. TSEBT was well tolerated, with minor toxicities such as xerosis, transient alopecia, distal onycholysis, and erythema. These results highlight the treatment's efficacy and safety, although the relapse rate underscores the need for combined strategies and long-term follow-up.

Conclusions: TSEBT has been shown to be an effective therapeutic option in patients with cutaneous T-cell lymphomas, achieving an ORR of 90.9% and significant reductions in tumor burden (average 65% on the mSWAT score). These results support its use, especially in settings where systemic therapies have shown limitations, and reinforce the effectiveness of TSEBT as a therapeutic modality even at moderate doses, although relapses remain common in advanced stages.