A Patient’s Guide to Understanding
Cutaneous Lymphoma
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Total skin electron beam therapy (TSEBT) has undergone many
modifications and advances through the years with the goal of delivering
the radiation to the target tissue (skin) and minimizing the damage to
surrounding tissues. TSEBT is administered in the out-patient hospital
setting under the direction of an expert radiation therapist. Typically
patients receive TSEBT daily for an approximate 10-week treatment cycle.
As a skin-directed therapy, TSEBT is highly effective for patients with
extensive skin involvement with plaque or tumor stage lesions.
SYSTEMIC THERAPIES
Extracorporeal Photopheresis (ECP)
Extracorporeal photopheresis (ECP) is an immunotherapy recommended
in cutaneous lymphoma patients with an abnormal circulating T-cell
population identified in the peripheral blood. During ECP, white blood
cells are separated out and exposed (outside the body) to UVA light and
then re-infused. It is believed that the UVA-exposed white blood cells
produce a vaccine-like effect against malignant T-cells. Other treatments
(interferons, Targretin®) are frequently used in concert with ECP therapy.
Nurses administer photopheresis treatments two successive days every 3-4
weeks in outpatient settings. ECP is most often used when there is blood
involvement. In ECP, the cells are bathed in psoralen before being exposed
to UVA light.
Oral Corticosteroids
Corticosteroids are medications used to treat a variety of skin diseases
that may be acute or chronic in nature. These agents share a wide
range of applications for a host of immune-mediated diseases. In
cutaneous lymphoma, oral corticosteroids may be used to down-regulate
inflammatory cells when the skin disease is extensive and symptoms
associated are remarkable.
Examples of corticosteroid medications include cortisone, prednisone,
and methylprednisolone. Prednisone can be prescribed as a taper whereby
the dosage is gradually reduced from 40-60 mg to 5 mg over the course
of a few weeks. In other circumstances, low dose prednisone (10-20 mg)
may be administered daily on a long-term basis. Some of the commonly
encountered side effects with long-term administration include fluid
retention, weight gain, increased blood pressure, increased blood sugar,
