Procedure
There are various technical options for radiotherapy that are suitable for treating the skin, with orthovoltage radiotherapy (= irradiation with X-rays) and radiotherapy with fast electrons being the most commonly used.
Orthovoltage radiotherapy is used to treat isolated lymphoma manifestations of the skin. Radiotherapy with electrons is also used and consists of very small electrically charged particles that are produced in a linear accelerator and directed at the skin. The radiation is focused into the affected skin layers and spares the deeper tissues and organs from the radiation effect, i.e. it is very harmful to the tumor cells, but is well tolerated by the surrounding normal skin cells.
Radiotherapy is carried out as an outpatient treatment and can therefore be easily integrated into everyday private and professional life. In the case of cutaneous lymphoma, it is usually “fractionated”. This means that patients receive small doses of radiation on consecutive working days in order to reduce side effects and maximize the benefits. This therapy lasts approx. 1-2 weeks and close and personal care during therapy is a matter of course for us.
The Department of Radiation Oncology at the USZ uses only the most modern techniques for the precise irradiation of cutaneous lymphomas with few side effects. State-of-the-art equipment and experienced medical physicists and MTRAs contribute to treatment of optimum quality and safety. You will be supervised by experts in the treatment of cutaneous lymphoma: Dr. Laura Morisi and Dr. C. Linsenmeier, MSc.
Our team works closely with our colleagues from the Hemato-Oncology department and the Dermatology department to guarantee “one-stop” treatment. In clinical trials, we are continuously working on improving the treatment of cutaneous lymphoma to make it even more effective and tolerable. To the overview of currently open studies.
In the following, we will describe radiotherapy for the different types and stages of cutaneous lymphoma:
Primary cutaneous B-cell lymphomas
The most important treatment options for isolated or grouped foci of all forms of cutaneous B-cell lymphoma are total excision by surgery and/or radiotherapy. Radiotherapy can be used either as the sole treatment or as part of a multimodal approach (together with systemic treatments).
The treatment options differ depending on the clinical behavior. Cutaneous lymphomas that show a so-called “indolent”, less aggressive behavior, such as primary cutaneous germinal center lymphomas or primary cutaneous marginal zone B-cell lymphomas, are very radiosensitive and respond very well to radiotherapy. Almost all patients with indolent forms and solitary or relatively few skin lesions can be cured both with surgery and with local, low-dose radiotherapy alone.
However, despite successful surgery or radiotherapy, some patients experience a relapse during the course of the disease. We refer to this as recurrence. In the event of a recurrence, a local form of therapy can still be used without worsening the overall prognosis. Radiation therapy can then be considered again. For patients with multiple lesions, radiotherapy or observation (i.e. “watch and wait”) are sensible options; sometimes systemic therapy is also necessary. As soon as the lesions become symptomatic, they can be irradiated (or surgically removed).
In cutaneous lymphomas with intermediate clinical behavior, such asprimary cutaneous diffuse large B-cell lymphoma (PCLBCL), the response rate is somewhat lower and the risk of relapse is increased. Since the clinical behavior of PCLBCL is similar to systemic diffuse large B-cell lymphomas (DLBCL), these should be treated primarily systemically with or without radiotherapy in the case of multiple foci.
Primary cutaneous T-cell lymphomas: mycosis fungoides and Sézary syndrome
Local radiotherapy is effective for isolated, localized cutaneous tumors or chronic, painful or ulcerated lesions, with complete response rates of >90%. The treatment is divided into several sessions.
Transformed forms and lesions of the lower extremities, which are associated with poor circulation and wound healing, often have lower response rates. Radiosensitizing drugs together with low-dose local radiotherapy can help.
In rapidly progressive, refractory/relapsing and extensive disease, radiation is administered to the entire skin surface; this treatment is aimed at slowing down the course of the disease and alleviating the symptoms.