Real-world Pattern-of-Care Analysis of Cutaneous Lymphomas Radiotherapy Among EORTC Members

Khaled Elsayad; Emmanuella Guenova; Beatrice Fournier; Carolina Fernandes; Enrico Clementel; Evangelia Papadavid; Marie Beylot Barry; Felix Pavlotsky; Lena Specht; Mario Levis; Stephen Morris; Belinda Campbell; Jan P Nicolay; Richard Cowan; Dora Correia; Chalid Assaf; Pablo L Ortiz-Romero; Vassilis Kouloulias; Adele de Masson; Stephane Dalle; Pierre Clavère; Max Schlaak; Nina Booken; Marion Wobser; Christina Mitteldorf; Barzilai Aviv; Virgínia Mareco; Fernando Gallardo; Reinhard Dummer; Markus Gross; Felix Ehret; Andrea Lancia; Bartłomiej Tomasik; Lorna Hawley; Vincent Rermouchamps; Mona Abdel-Halim Ibrahim; Ahmed Gawish; Mohamed Abouegylah; Martin Stuschke; Adinda Baten; Hans Theodor Eich; EORTC cutaneous lymphoma study group

doi:10.1016/j.ijrobp.2024.11.011

Real-world Pattern-of-Care Analysis of Cutaneous Lymphomas Radiotherapy Among EORTC Members

Int J Radiat Oncol Biol Phys. 2024 Nov 14:S0360-3016(24)03581-8. doi: 10.1016/j.ijrobp.2024.11.011. Online ahead of print.

Authors

Khaled Elsayad¹, Emmanuella Guenova², Beatrice Fournier³, Carolina Fernandes³, Enrico Clementel³, Evangelia Papadavid⁴, Marie Beylot Barry⁵, Felix Pavlotsky⁶, Lena Specht⁷, Mario Levis⁸, Stephen Morris⁹, Belinda Campbell¹⁰, Jan P Nicolay¹¹, Richard Cowan¹², Dora Correia¹³, Chalid Assaf¹⁴, Pablo L Ortiz-Romero¹⁵, Vassilis Kouloulias¹⁶, Adele de Masson¹⁷, Stephane Dalle¹⁸, Pierre Clavère¹⁹, Max Schlaak²⁰, Nina Booken²¹, Marion Wobser²², Christina Mitteldorf²³, Barzilai Aviv⁶, Virgínia Mareco²⁴, Fernando Gallardo²⁵, Reinhard Dummer²⁶, Markus Gross²⁷, Felix Ehret²⁸, Andrea Lancia²⁹, Bartłomiej Tomasik³⁰, Lorna Hawley³¹, Vincent Rermouchamps³², Mona Abdel-Halim Ibrahim³³, Ahmed Gawish³⁴, Mohamed Abouegylah³⁵, Martin Stuschke³⁶, Adinda Baten³⁷, Hans Theodor Eich³⁸; EORTC cutaneous lymphoma study group

Affiliations

¹ Radiation Oncology, University Hospital of Muenster, Muenster, Germany. Electronic address: [email protected].
² Department of Dermatology, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland.
³ European Organisation for Research and Treatment of Cancer, Headquarters, Brussels, Belgium.
⁴ Department of Dermatology-Venereology, National and Kapodistrian University of Athens, Athens, Greece.
⁵ Department of Dermatology, University Hospital of Bordeaux and INSERM U1312, France.
⁶ Dermatology Department, Sheba Medical Center Tel Hashomer, Israel.
⁷ Department of Oncology, Copenhagen University Hospital - Rigshospitalet, Copenhagen, Denmark.
⁸ Department of Oncology, University of Torino, Torino, Italy.
⁹ Guy s and St Thomas' NHS - Guy's Hospital, London, UK.
¹⁰ Department of Radiation Oncology, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia; The Sir Peter MacCallum Department of Oncology, Department of Clinical Pathology, University of Melbourne, Parkville, Victoria, Australia.
¹¹ Department of Dermatology, Venereology and Allergology, University Medical Center Mannheim, Mannheim, Germany.
¹² Department of Clinical Oncology, Christie Hospital, University of Manchester, Manchester, United Kingdom.
¹³ Department of Radiation Oncology, Cantonal Hospital Aarau, Aarau, Aargau, Switzerland; Department of Radiation Oncology, Inselspital, Bern University Hospital, University of Bern, Switzerland.
¹⁴ Department of Dermatology, HELIOS Klinikum Krefeld, Krefeld, Germany; Institute for Molecular Medicine, Medical School Hamburg, University of Applied Sciences and Medical University, Hamburg, Germany; Department of Dermatology, HELIOS Klinikum Schwerin, University Campus of The Medical School Hamburg, Schwerin, Germany.
¹⁵ Department of Dermatology, Institute i+12, Hospital 12 de Octubre Medical School, University Complutense, Madrid, Spain.
¹⁶ Department of Radiation Oncology, National and Kapodistrian University of Athens, Athens, Greece.
¹⁷ Department of Dermatology, APHP, Saint-Louis University Hospital, Paris, France.
¹⁸ Department of Dermatology, Hospices Civils de Lyon, 69495 Pierre Bénite CEDEX, France.
¹⁹ Department of Radiotherapy, Centre Hospitalier Universitaire de Limoges, Limoges, France.
²⁰ Department of Dermatology, Venereology and Allergology, Charite - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany.
²¹ Department of Dermatology and Venerology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.
²² Department of Dermatology, Universitaetsklinikum Wuerzburg, Germany.
²³ Department of Dermatology, University Medical Center Göttingen, Germany.
²⁴ Radiotherapy Department, Unidade Local de Saúde Santa Maria, EPE, Portugal.
²⁵ Department of Dermatology, Hospital del Mar, Barcelona, Spain.
²⁶ Department of Dermatology, University Hospital Zurich, Switzerland.
²⁷ Department of Radiooncology, University Hospital Basel, Basel, Switzerland.
²⁸ Department of Radiation Onology, Charité - Universitätsmedizin Berlin, Campus Virchow-Klinikum, Berlin, Germany.
²⁹ Fondazione IRCCS Policlinico San Matteo, Pavia, Italy.
³⁰ Department of Oncology and Radiotherapy, Faculty of Medicine, Medical University of Gdańsk, Gdańsk, Poland.
³¹ Bristol Haematology and Oncology Centre.
³² CHU UCL Namur Site Elisabeth, Namur, Belgium.
³³ Dermatology Department, Ain Shams University, Cairo, Egypt.
³⁴ Department of Radiotherapy and Radiation Oncology, Philipps-Universität Marburg, Deutschland. Marburg Ion-Beam Therapy Center (MIT), Marburg University Hospital, University Cancer Center (UCT) Frankfurt - Marburg, Marburg, Germany.
³⁵ Department of Clinical Oncology, Alexandria University Hospital and Ayadi Al-Motakbal Hospital.
³⁶ Department of Radiation Oncology, University Hospital Essen, Germany.
³⁷ Department of Radiation Oncology, UZ Leuven, Leuven, Belgium.
³⁸ Radiation Oncology, University Hospital of Muenster, Muenster, Germany.

PMID: 39549760
DOI: 10.1016/j.ijrobp.2024.11.011

Abstract

Purpose: We aim to determine the current treatment patterns and recommendations among physicians for cutaneous lymphomas and to identify the types of skin lymphomas for which existing radiation regimens need improvement.

Materials/methods: A questionnaire from the European Organisation for Research and Treatment of Cancer (EORTC) was distributed to all members of the Cutaneous Lymphoma Tumour Group and radiation oncology scintific council. This online survey included 13 questions regarding treatment practices for patients with cutaneous lymphoma. The survey was conducted from August 21 to December 18, 2023. Frequency distributions and subgroup comparisons were calculated and analyzed.

Results: We collected 51 completed questionnaires from investigators from 19 countries specializing in cutaneous lymphoma treatment. Radiation doses varied significantly (range, 4-60 Gy). Based on the histologic entity, up to one-third of the investigators delivered hypofractionated regimens (range, 14% - 35%). Reduced-dose radiotherapy was considered by 27% to 63% of investigators. Meanwhile, 18 (35%) investigators considered adapting the radiation dose to the response to immunochemotherapy when treating primary cutaneous diffuse large B-cell lymphomal-leg type. Regarding total skin electron beam therapy, 91% of centres delivered reduced-dose regimens, and 18% of investigators applied ultra-hypofractionated protocols.

Conclusion: Radiotherapy of cutaneous lymphoma patients is highly heterogeneous among EORTC centres. Development of evidence-based recommendations for radiotherapy dose, fractionation, and technique for cutaneous lymphomas is required for optimization and standardization of treatment.

Keywords: Sézary syndrome; anaplastic large cell lymphoma; cutaneous B cell lymphoma; cutaneous T cell lymphoma; diffuse large B cell lymphoma; follicular lymphoma; hypofractionation; low dose; marginal zone lymphoma; mycosis fungoides; overtreatment.