Helical Irradiation of Total Skin (HITS) for Cutaneous Lymphoma

Inclusion Criteria: 1. The stage I-IV cutaneous T-cell lymphoma (CTCL) of International Society Cutaneous Lymphomas (ISCL) and U.S. Cutaneous Lymphoma Consortium (USCLC)/European Organization for Research \& Treatment of Cancer (EORTC), patients who are candidates for TSEB by recommendation of National Comprehensive Cancer Network Guidelines (Version 4.2011, Mycosis fungoid/Sezary syndrome) 2. Patients who are refractory or not feasible to the topic UV irradiation, Interferon alpha, psoralen plus ultraviolet A photochemotherapy, and Isotretinoin or chemotherapy. 3. Eligibility criteria included the following: Karnofsky status 70% or greater; creatinine clearance greater than 50 mL/min; cardiac left ventricular ejection fraction 50% or greater; aspartate aminotransferase and alanine aminotransferase less than 2.5 times the upper limits of institutional normal; adequate pulmonary function as shown by a forced expiratory volume of greater than 60%; and peripheral neuropathy grade 1 or lower. Patients were preassessed for their ability to lie supine for approximately 1 hour. 4. They had to be previously untreated TSEBT. Prior local radiation was permitted. 5. All patients voluntarily signed an informed consent form approved by the Institutional Review Board. Exclusion Criteria: 1. Patient were prior treated by TSEBT for CTCL, another type of cancer, abnormal cardiac function (systolic ejection fraction \< 50 percent or an abnormal stress test), chronic respiratory disease (vital capacity or carbon monoxide diffusion, \< 50 percent of normal), abnormal liver function (serum bilirubin, \> 2.0 mg per deciliter \[\>35 micromol per liter\]; or serum aminotransferase values more than four times the normal value), and psychiatric disease. 2. Females who are pregnant/lactating or planning to be pregnant. 3. Patients with other systemic diseases that required long-term (≥ 2 weeks) usage of glucocorticosteroid or immunosuppressant agent(s) within 4 weeks prior to the initiation of study treatment. 4. Child or handicap are excluded