Cutaneous T-cell lymphoma: Trends in radiation doses and patterns of care 2004-2015

Background and Aim: Radiotherapy is an effective treatment for cutaneous T-cell lymphoma (CTCL). Since 2009, studies have advocated for low-dose radiotherapy (<30 Gy) given it results in similar response rates and less toxicity compared to higher doses (≥30 Gy). We aimed to see if low-dose radiotherapy has been adopted on a national scale in the USA. Materials and Methods: A total of 11,292 adult patients with CTCL were identified in the National Cancer Database. Logistic regression models were created to evaluate predictors for use of low-dose radiotherapy. Results: A minority of patients received low-dose radiotherapy (22.4%). The annual percentage of patients receiving low-dose radiotherapy increased from 17.2% in 2009 to 38.4% in 2015. High-volume facilities were associated with use of low-dose radiotherapy (5th quintile vs. bottom two quintiles, odds ratio(OR)=1.76, 95% confidence interval(CI)=1.22-2.54, p=0.003). Conclusion: Although the radiotherapy dose administered is decreasing, most patients with CTCL are still receiving doses that may be higher than needed to palliate their disease effectively.