Predictors of radiation-induced skin reactions in patients with T-cell skin lymphomas after total skin irradiation: retrospective cohort study

Abstract

INTRODUCTION: Skin reactions negatively affect a patient’s quality of life and may require radiation therapy premature interruption, what impairs illness control. Numerous agents determine tissue radiosensitivity, but demographic and lifestyle factors remain poorly understood. Those kind of patients herapeutic algorithm demands studies.OBJECTIVE: Radiation-induced skin reactions (RISR) formation and severity prognostic factors determination for primary malignant skin lymphomas patients.MATERIALS AND METHODS: 45 patients malignant T-cell skin lymphoma study, aged 38 to 82 years (29 mycosis fungoides patients, 2 lymphomatoid papulosis, 14 patients with primary anaplastic large cell skin lymphoma) received fast electrons total skin irradiation on the basis of the Federal State Institution «Russian Radiology and Surgical Technologies Scientific Center named after Academician A.M.Granov» of the Ministry of Health of the Russian Federation from 2012 to June 2022. Radiation therapy performed in the usual fractionation mode on linear electron accelerators Elekta Precise with 4–6 MeV bremsstrahlung total doses from 14 to 30 Gy (22±2.4 Gy). In order to identify the role of possible prognostic factors of skin toxicity — gender, age, body mass index (BMI), smoking status, lymphoma body surface area (BSA), the presence of concomitant diseases (diabetes mellitus and arterial hypertension) and previous chemotherapy.Statistics: Statistical analysis was performed using the IBM SPSS Statistics v. 26 program (developed by IBM Corporation). The value of p<0.05 was considered statistically significant. Verification of the sample belonging to the normal general population was carried out using the Shapiro–Wilk criterion. Spearman's rank correlation coefficient was used for correlation analysis. The regression parameters were estimated using the least squares method.RESULTS: The analysis revealed positive associations between the severity of RISR and predictor factors: BMI (r=0.799, p<0.01), smoking status (r=0.655, p<0.01), age (r=0.534, p<0.05), presence of diabetes mellitus (r=0.456, p<0.05), arterial hypertension (r=0.227, p<0.05), previous chemotherapy (r=0.422, p<0.01) and lymphoma body surface area (r=0.378, p<0.01). Severity of RISR scale value increase by those parameters. Negative links found between the severity of RISR and the total focal dose (SOD) of the beginning of their formation (r=–0.109, p<0.05).CONCLUSION: Formation and severity prognostic factors for the RCC upon fast electrons total skin exposure for patients with primary malignant T-cell skin lymphomas (mycosis fungoides, lymphomatoid papulosis, primary anaplastic large cell lymphoma of the skin) were identified.