Lymphoma — oncbrain

2026-05-22

EORTC Cutaneous Lymphoma RT Recommendations

TL;DR≥92% 1yr local control with low-dose RT (8-12 Gy) in MF; EORTC consensus algorithm standardizes per-entity dosing absent RCTs.

Why it mattersRadiation oncology

The actionable read is dose: 8-12 Gy in 2-3 fx clears ≥92% 1yr local control in MF, while 4 Gy underperforms, so ultra-low-dose trades control for fewer visits. The EORTC algorithm sets a per-entity dose floor where no RCT exists, reserving 24 Gy for bulky lesions or pre-transplant remission.

vs leading data

Folliculotropic MF: RT more effective than other modalities (Dutch registry, n=203, retrospective)

Radiation Consensus / guideline

6 details 5 trials watching

Methods

💊 Sézary syndrome: TSEBT controversial, rarely durable; systemic effect lowers circulating Sézary cells
🔍 Expert consensus / literature review; no completed RCTs defining standard dose per entity
🔍 EORTC algorithm (Figs 2A/2B) standardizes per-entity dose recommendations across centres

Results

📊 Low-dose RT in MF: 1yr local control ≥92%

📊 Recommended RT dose by cutaneous lymphoma entity

Entity	RT dose / fractionation
MF, localized plaques/tumours	8-12 Gy in 2-3 fx
MF, >10% BSA (TSEBT)	8-12 Gy palliative; up to 24 Gy pre-autologous SCT
Cutaneous DLBCL, leg type	16-45 Gy (4 Gy/wk up to 40 Gy)

Critique

⚠️ 4 Gy (1-2 fx) gave inferior local control vs 8-12 Gy in MF

Open questions

Standard radiation dose per cutaneous lymphoma entity (no completed RCT)

active Low Dose Radiotherapy in Primary Indolent Cutaneous B-cell Lymphoma

n=52 · primary completion 2025-12 · 4 Gy low-dose RT in cutaneous B-cell entity

recruiting Low-Dose Total Skin Electron Therapy in Treating Patients With Refractory or Relapsed Stage IB-IIIA Mycosis Fungoides

n=60 · primary completion 2026-09 · low-dose total skin electron therapy in MF

recruiting Ultra Low Dose Radiation Therapy in Treating Patients With Mycosis Fungoides Phase 2

n=50 · primary completion 2027-12 · phase 2 ultra-low-dose RT in MF
Factors predicting outcome after different radiation doses
Optimal low-dose RT combined with immunomodulatory/systemic agents

recruiting Effectiveness of Concurrent Ultra-Low-Dose Total-Skin Electron Beam Therapy and Brentuximab Vedotin Given Quarterly Over 12 Months for Patients With Mycosis Fungoides Phase 2

n=30 · primary completion 2027-01 · ULD-TSEBT + brentuximab vedotin

recruiting Combining Topical Imiquimod With Local Radiotherapy for Treatment of Mycosis Fungoides Phase Early 1

n=25 · primary completion 2027-06 · concurrent imiquimod + RT, both doses studied

📚 Sources · 📄 1 paper

📄 PAPER Khaled Elsayad; Emmanuella Guenova; Chalid Assaf et al. · European Journal of Cancer (2024)

Radiotherapy in cutaneous lymphomas: Recommendations from the EORTC cutaneous lymphoma tumour group

doi