Impact of Gender and Race on Outcomes of Patients Treated for Mycosis Fungoides with Total Skin Electron Beam Therapy
Schaff E, Bergman D, Burmeister C, McHargue C, Lim H, and Siddiqui F. Impact of Gender and Race on Outcomes of Patients Treated for Mycosis Fungoides with Total Skin Electron Beam Therapy. International Journal of Radiation Oncology Biology Physics 2020; 108(2):E47.
International Journal of Radiation Oncology - Biology - Physics
Background: Race and gender have been shown to affect patient outcomes in many different types of cancer. However, there is just one other paper which explores this in mycosis fungoides. Our institution is well suited for studying these disparities due to our diverse patient population.
Objectives: To determine the impact of patient characteristics such as race and gender on the survival outcomes of patients with mycosis fungoides who have undergone total skin electron beam therapy as part of their treatment regimen.
Methods: After IRB approval, 25 patients with mycosis fungoides who have undergone 26 courses of total skin electron beam therapy (TSEBT) were included in this analysis (one patient with 2 courses of TSEBT). These patients were treated between 2010 and 2019 with 36 Gy in 24 fractions over 8 weeks using the Stanford 6 technique. Data points were collected from all available medical records. Patients were stratified by race and by gender.
Results: Patients were evenly distributed, with 13/25 African American (AA) vs 12/25 Caucasian, and 10/25 female vs 15/25 male. With a median follow up of 17 months (range 1-67 months), the progression free survival (PFS) at 6 months in African Americans vs Caucasians was 22% vs 39% (p=0.25) and at 1 year it was 7% vs 20% (p=0.18). When comparing by gender, the 6 month PFS for female vs male was 27% vs 33% (p=0.95) and at 1 year was 16% vs 11% (p=0.96). Overall survival (OS) at 1 year in AA vs Caucasians was 100% vs 73% (p=N/A) and at 2 years it was 71% vs 62% (p=0.55). When comparing by gender, the 1 year OS for female vs male was 89% vs 80% (p=0.52) and at 2 years it was 78% vs 53% (p=0.35). There were no significant differences in age, diagnosis to treatment time, previous treatment, or previous radiation therapy between the groups when comparing by race or by gender.
Conclusions: To date there has been only one other paper addressing the factors of race and gender on the outcomes of TSEBT, and this paper had a relatively low percentage of AA patients (22%). In our study where the representation of AA patients is 52%, we confirmed that there is no significant difference in survival outcomes based on the patient’s race. This was similarly observed in the comparison by gender as well. A major limitation of this study was the small sample size, as well as the retrospective nature of the analysis. Significantly, this study reinforces the point that in patients with Mycosis Fungoides, progression is almost inevitable and a multidisciplinary approach is the only effective means of management.