Sobolewski Piotr, Koper Mateusz, Ciechanowicz Piotr, Walecka Irena
Dermatology Clinic, National Institute of Medicine of the Ministry of Interior and Administration, 02-507 Warsaw, Poland.
Cancers (Basel). 2025 Aug 22;17(17):2722. doi: 10.3390/cancers17172722.
Primary cutaneous lymphomas (PCLs), including cutaneous T-cell lymphomas (CTCL) and primary cutaneous B-cell lymphomas (PCBCL), are a diverse group of non-Hodgkin lymphomas that primarily affect the skin. Radiotherapy (RT) plays a pivotal role in the treatment of these lymphomas, particularly for localized disease, due to its ability to deliver precise, skin-directed treatment. Mycosis fungoides (MF) and Sézary syndrome (SS), the most common subtypes of CTCL, often require skin-directed therapies such as electron beam therapy and superficial brachytherapy to manage localized lesions. Electron beam therapy, including total skin electron beam therapy (TSEBT), has been utilized for decades, offering high response rates but with the risk of cumulative skin toxicity. Recently, low-dose radiotherapy (LDRT) has gained attention as an effective alternative that reduces toxicity while maintaining durable responses. Superficial brachytherapy is another modality that delivers radiation through custom molds, allowing for homogeneous dosing over complex anatomical areas like the face. Both teleradiotherapy and brachytherapy have demonstrated high complete response rates, with low recurrence rates observed when higher doses are used. In the context of primary cutaneous B-cell lymphomas, such as primary cutaneous marginal zone lymphoma (PCMZL) and primary cutaneous follicle center lymphoma (PCFCL), radiotherapy also offers excellent local control, particularly for indolent subtypes. However, more aggressive subtypes, such as diffuse large B-cell lymphoma, leg type (PCDLBCL-LT), may require systemic therapies in addition to radiation. Overall, teleradiotherapy and brachytherapy are essential components of the therapeutic arsenal for primary cutaneous lymphomas, offering effective disease control with manageable toxicity, while ongoing research focuses on optimizing treatment strategies and exploring novel combinations with systemic therapies.
原发性皮肤淋巴瘤（PCL），包括皮肤T细胞淋巴瘤（CTCL）和原发性皮肤B细胞淋巴瘤（PCBCL），是一组主要累及皮肤的非霍奇金淋巴瘤。放射治疗（RT）在这些淋巴瘤的治疗中起着关键作用，特别是对于局限性疾病，因为它能够提供精确的、针对皮肤的治疗。蕈样肉芽肿（MF）和 Sézary 综合征（SS）是CTCL最常见的亚型，通常需要如电子束治疗和浅表近距离放射治疗等针对皮肤的疗法来处理局限性病变。电子束治疗，包括全身皮肤电子束治疗（TSEBT），已经使用了数十年，具有高缓解率，但存在累积皮肤毒性的风险。最近，低剂量放射治疗（LDRT）作为一种有效的替代方法受到关注，它在保持持久缓解的同时降低了毒性。浅表近距离放射治疗是另一种通过定制模具进行放射治疗的方式，能够在面部等复杂解剖区域实现均匀剂量给药。远距离放射治疗和近距离放射治疗均显示出高完全缓解率，使用较高剂量时复发率较低。在原发性皮肤B细胞淋巴瘤，如原发性皮肤边缘区淋巴瘤（PCMZL）和原发性皮肤滤泡中心淋巴瘤（PCFCL）的情况下，放射治疗也能提供出色的局部控制，特别是对于惰性亚型。然而，更具侵袭性的亚型，如弥漫性大B细胞淋巴瘤，腿部型（PCDLBCL-LT），可能除了放射治疗外还需要全身治疗。总体而言，远距离放射治疗和近距离放射治疗是原发性皮肤淋巴瘤治疗武器库的重要组成部分，能够有效控制疾病且毒性可控，同时正在进行的研究专注于优化治疗策略以及探索与全身治疗的新型联合方案。
