The effect of phototherapy on progression to tumors in patients with patch and plaque stage of mycosis fungoides

Abstract

Background: Phototherapy has been a mainstay in the treatment of mycosis fungoides (MF). However, the recent findings of UV-induced p53 mutations in advanced MF suggest that phototherapy may contribute to disease progression.

Objective: The objective of this study was to evaluate the effect of phototherapy on the time to tumor progression and overall survival in MF.

Materials and methods: Retrospective analysis of patients seen at the University of Pittsburgh Cutaneous Lymphoma Clinic from 1979 to 2016.

Results: A total of 345 patients with MF were identified. 258 (74.8%) were diagnosed at stage IA or IB. 43 out of the 258 (16.6%) progressed to tumor stage. Before tumor development, 30 out of the 43 (69.8%) patients received phototherapy, and 13 (30.2%) did not. Patients who received phototherapy had a longer median time to tumor progression than those who did not: 3.5 years (interquartile range = 1.9–5.7) versus 1.2 years (0.2–2.3) (p = .001). Patients who received phototherapy also survived longer: 6.9 years (interquartile range = 4.3–9.5) versus 3.8 years (3.0–4.5) (p = .014).

Limitations: Limited information on specific phototherapy start dates, durations, and treatment protocols.

Conclusions: The therapeutic effects of phototherapy, with longer times to tumor progression and increased overall survival, appear to outweigh its potential adverse effects.

Keywords:

• Mycosis fungoides
• cutaneous T-cell lymphoma
• tumor stage
• phototherapy
• rate of progression
• PUVA
• NB UVB

Acknowledgements

The authors would like to thank Sue McCann for clinical coordination and Vladimir Lamm for his help with data acquisition.

Disclosure statement

No potential conflict of interest was reported by the authors.

Additional information

Funding

This work was supported by National Cancer Institute grant 5P50CA121973–08. The statistical analyses were performed by the Clinical Translational Science Institute at the University of Pittsburgh and were supported by the National Institutes of Health Grant Number UL1-TR-001857.