Specht Lena
Department of Oncology, Copenhagen University Hospital - Rigshospitalet, Copenhagen, Denmark.
Front Oncol. 2025 Apr 1;15:1498855. doi: 10.3389/fonc.2025.1498855. eCollection 2025.
Primary cutaneous lymphomas are highly radiosensitive. X-rays work well for localized cutaneous lymphomas. However, if disseminated in the skin and covering larger areas, as is commonly the case with the most common type, mycosis fungoides, x-ray therapy is not suited because the dose to underlying organs exceeds their tolerance. By contrast, electrons have a limited range of penetration, and are ideal for treating superficial lesions. Techniques have been developed to yield a fairly uniform dose to the entire skin surface and treating to a depth of about 1-1½ cm. Total skin electron beam therapy (TSEBT) is probably the most effective skin directed therapy for widespread primary cutaneous lymphomas. For many years the total dose used for mycosis fungoides was 30-36 Gy, given in small fractions. This treatment could only be repeated once. However, total doses of 10-12 Gy have now been shown to offer excellent response rates, and the treatment can be repeated up to 6 times, offering as much or probably even more palliation than the high-dose treatment. Today, most patients are treated with low-dose TSEBT, the higher doses reserved for patients with more resistant disease. Attempts have been made to use photon therapy for total skin irradiation, e.g., tomotherapy. However, even with the most meticulous of techniques there is too much dose in deeper structures, resulting in bone marrow toxicity even with low-dose treatment. This is never seen with electrons, even with high-dose therapy. Further research into optimizing TSEBT and exploring combinations with systemic treatments is ongoing.
原发性皮肤淋巴瘤对放疗高度敏感。X射线对局限性皮肤淋巴瘤效果良好。然而，对于皮肤播散且累及较大面积的情况，如最常见的蕈样肉芽肿，X射线治疗并不适用，因为对深层器官的剂量会超过其耐受度。相比之下，电子的穿透范围有限，是治疗浅表病变的理想选择。现已开发出相关技术，可使整个皮肤表面获得相当均匀的剂量，并能治疗至约1 - 1.5厘米的深度。全身皮肤电子束治疗（TSEBT）可能是治疗广泛原发性皮肤淋巴瘤最有效的皮肤定向治疗方法。多年来，用于蕈样肉芽肿的总剂量为30 - 36 Gy，分小剂量给予。这种治疗只能重复一次。然而，现已证明10 - 12 Gy的总剂量能产生极佳的缓解率，且该治疗可重复多达6次，与高剂量治疗相比，能提供同等甚至更多的姑息治疗效果。如今，大多数患者接受低剂量TSEBT治疗，高剂量则保留给病情更顽固耐药的患者。人们曾尝试使用光子疗法进行全身皮肤照射，例如断层放疗。然而，即便采用最精细的技术，深层结构中的剂量仍过高，即使是低剂量治疗也会导致骨髓毒性。而电子治疗即便采用高剂量疗法也不会出现这种情况。目前正在进行进一步研究，以优化TSEBT并探索其与全身治疗的联合应用。
